Changes to surgical and hospitalization rates of pediatric inflammatory bowel disease in Ontario, Canada (1994–2007)

Authors

  • Eric I. Benchimol MD, PhD,

    Corresponding author
    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, Ontario, Canada
    3. Child Health Evaluative Sciences, University of Toronto, Ontario, Canada
    4. Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
    5. Department of Paediatrics, University of Toronto, Ontario, Canada
    • Division of Gastroenterology, Hepatology & Nutrition, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1 Canada
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  • Astrid Guttmann MDCM, MSc,

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
    3. Department of Paediatrics, University of Toronto, Ontario, Canada
    4. Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
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  • Teresa To PhD,

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Child Health Evaluative Sciences, University of Toronto, Ontario, Canada
    3. Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
    4. Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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  • Linda Rabeneck MD, MPH,

    1. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    2. Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
    3. Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
    4. Department of Medicine, University of Toronto, Ontario, Canada
    5. Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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  • Anne M. Griffiths MD

    1. Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, Ontario, Canada
    2. Department of Paediatrics, University of Toronto, Ontario, Canada
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  • Funded by a Clinical Research Award from the American College of Gastroenterology. Eric Benchimol was a Canadian Institutes of Health Research (CIHR) training fellow in the Canadian Child Health Clinician Scientist Program, in partnership with SickKids Foundation and the Child & Family Research Institute of British Columbia, and also supported by a fellowship from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition-Children's Digestive Health and Nutrition Foundation. Astrid Guttmann was supported by a CIHR New Investigator Award. Teresa To was supported by the University of Toronto Dales Award. Funders played no role in the study design, collection, analysis, and interpretation of the data or in the writing of the report.

  • Potential conflict of interest: Eric Benchimol has been a consultant and received educational funds from Merck/Schering-Plough Canada. Anne Griffiths has received research support from Merck/Schering-Plough Canada and has been a consultant for Abbott Canada, UCB Pharma, Centocor, and Merck/Schering-Plough.

Abstract

Background:

Recent advances have been made in the care of children with inflammatory bowel disease (IBD). We aimed to describe trends in medication use, associated health services, and outcomes (hospitalization and surgical rates) between 1994–2007 in children with IBD.

Methods:

Children <18 years diagnosed 1994–2004 with IBD living in Ontario were identified and grouped by era of diagnosis (1994–1997, 1998–2000, 2001–2004). We tested the association between era and hospitalizations and surgery. Medication use (in children on social assistance), and physician provider specialty were described.

Results:

IBD-related outpatient health services were increasingly provided by pediatric gastroenterologists, with decreasing care by adult gastroenterologists, surgeons, and generalists. Children diagnosed in 2001–2004 with Crohn's disease (CD) were more likely to use an immunomodulator within 3 years of diagnosis (P = 0.01). In all children with IBD, numbers of hospitalizations and physician visits remained stable over time; however, the age-adjusted odds of being hospitalized was higher in recent years for CD (adjusted odds ratio [aOR] 3.22, 95% confidence intervals [CI] 2.15–4.83) and ulcerative colitis (UC) (aOR 2.83 95% CI 1.55–5.19). Surgical rates within 3 years of diagnosis with CD decreased from 18.8% to 13.6% over time (P = 0.035). This decrease was significant in children with CD diagnosed ≥10 years old (aOR 0.67, 95% CI 0.48–0.93). No change was demonstrated in UC.

Conclusions:

Treatment changes in children with IBD between 1994–2007 (including increased immunomodulator use and increased outpatient care by pediatric gastroenterologists) were associated with reduced surgical rates in children with CD but not UC. (Inflamm Bowel Dis 2011;)

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