TY - JOUR
T1 - Health Services Utilization, Specialist Care, and Time to Diagnosis with Inflammatory Bowel Disease in Immigrants to Ontario, Canada
T2 - A Population-Based Cohort Study
AU - Benchimol, Eric I.
AU - Manuel, Douglas G.
AU - Mojaverian, Nassim
AU - Mack, David R.
AU - Nguyen, Geoffrey C.
AU - To, Teresa
AU - Guttmann, Astrid
N1 - Funding Information:
Supported by a grant from the Ontario Ministry of Health and Long-Term Care Academic Health Sciences Centre Alternate Funding Plan Innovation Fund. E. I. Benchimol was supported by a Career Development Award from the Canadian Child Health Clinician Scientist Program. E. I. Benchimol and G. C. Nguyen were supported by New Investigator Awards from CIHR, Crohn's and Colitis Canada, and the Canadian Association of Gastroenterology. A. Guttmann is supported by a CIHR Chair in Reproductive and Child Health Services and Policy Research
Publisher Copyright:
Copyright © 2016 Crohn's & Colitis Foundation of America, Inc.
PY - 2016/8/26
Y1 - 2016/8/26
N2 - Background: Canada has amongst the highest incidence of inflammatory bowel disease (IBD) in the world, and the highest proportion of immigrants among G8 nations. We determined differences in prediagnosis delay, specialist care, health services use, and risk of surgery in immigrants with IBD. Methods: All incident cases of IBD in children (1994-2009) and adults (1999-2009) were identified from population-based health administrative data in Ontario, Canada. Linked immigration data identified those who arrived to Ontario after 1985. We compared time to diagnosis, postdiagnosis health services use (IBD specific and related), physician specialist care in immigrants and nonimmigrants, and risk of surgery between immigrants and nonimmigrants. Results: Thousand two hundred two immigrants were compared with 22,990 nonimmigrants. Immigrants had similar time to diagnosis as nonimmigrants for Crohn's (hazard ratio [HR] 1.002; 95% confidence intervals [CIs] 0.89-1.12) and ulcerative colitis (HR 1.073; 95% CI 0.95-1.21). For outpatient visits, immigrants with IBD were seen by gastroenterologists more often than nonimmigrants. Immigrants had greater IBD-specific outpatient health services use after diagnosis (odds ratio 1.24; 95% CI 1.15-1.33), emergency department visits (odds ratio 1.57, 95% CI 1.30-1.91), and hospitalizations (odds ratio 1.19; 95% CI 1.02-1.40). In immigrants, there was lower risk of surgery for Crohn's (HR 0.66, 95% CI 0.43-0.99) and ulcerative colitis (HR 0.52, 95% CI 0.31-0.87). Conclusions: Immigrants to Canada had greater outpatient and specialty care and lower risk of surgery, with no delay in diagnosis, indicating appropriate use of the health system.
AB - Background: Canada has amongst the highest incidence of inflammatory bowel disease (IBD) in the world, and the highest proportion of immigrants among G8 nations. We determined differences in prediagnosis delay, specialist care, health services use, and risk of surgery in immigrants with IBD. Methods: All incident cases of IBD in children (1994-2009) and adults (1999-2009) were identified from population-based health administrative data in Ontario, Canada. Linked immigration data identified those who arrived to Ontario after 1985. We compared time to diagnosis, postdiagnosis health services use (IBD specific and related), physician specialist care in immigrants and nonimmigrants, and risk of surgery between immigrants and nonimmigrants. Results: Thousand two hundred two immigrants were compared with 22,990 nonimmigrants. Immigrants had similar time to diagnosis as nonimmigrants for Crohn's (hazard ratio [HR] 1.002; 95% confidence intervals [CIs] 0.89-1.12) and ulcerative colitis (HR 1.073; 95% CI 0.95-1.21). For outpatient visits, immigrants with IBD were seen by gastroenterologists more often than nonimmigrants. Immigrants had greater IBD-specific outpatient health services use after diagnosis (odds ratio 1.24; 95% CI 1.15-1.33), emergency department visits (odds ratio 1.57, 95% CI 1.30-1.91), and hospitalizations (odds ratio 1.19; 95% CI 1.02-1.40). In immigrants, there was lower risk of surgery for Crohn's (HR 0.66, 95% CI 0.43-0.99) and ulcerative colitis (HR 0.52, 95% CI 0.31-0.87). Conclusions: Immigrants to Canada had greater outpatient and specialty care and lower risk of surgery, with no delay in diagnosis, indicating appropriate use of the health system.
KW - epidemiology
KW - health administrative data
KW - health services research
KW - immigrants
KW - inflammatory bowel disease
UR - http://www.scopus.com/inward/record.url?scp=84988646218&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84988646218&partnerID=8YFLogxK
U2 - 10.1097/MIB.0000000000000905
DO - 10.1097/MIB.0000000000000905
M3 - Article
C2 - 27556836
AN - SCOPUS:84988646218
SN - 1078-0998
VL - 22
SP - 2482
EP - 2490
JO - Inflammatory Bowel Diseases
JF - Inflammatory Bowel Diseases
IS - 10
ER -