A215 CHANGING INCIDENCE OF INFLAMMATORY BOWEL DISEASE IN THE PEDIATRIC POPULATION OF BRITISH COLUMBIA. (1st March 2018)

• Record Type: Journal Article
• Authors: Chan, J M; Carroll, M W; Smyth, M; Hamilton, Z; Prosser, R; Evans, D; Rosenfeld, G; Jacobson, K
• Is Part Of: Journal of the Canadian Association of Gastroenterology. Volume 1(2018)Supplement 1
• Page Start: 376
• Page End: 377
• Publication Date: 2018-03-01
• Subjects: Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1093/jcag/gwy008.216
• Languages: English
• ISSNs: 2515-2084

Abstract

Abstract: Background: Inflammatory Bowel Disease (IBD) is a chronic relapsing intestinal inflammatory disease that manifests most often early in life. Though rarely fatal, there is no cure thereby requiring life-long management with significant health care burden. Canada presents a robust platform for administrative health database study with its single payer health care system and high prevalence of IBD. The incidence rate of childhood onset of IBD has been increasing worldwide and increases in pediatric IBD have been found in Ontario but no study has been undertaken in British Columbia (BC). Our group obtained an IBD cohort from the BC Ministry of Health with full hospitalization, physician services and drug dispensation databases between 1991 and 2011. Aims: Applying an Ontario-derived validated case definition of IBD, we aimed to determine the province-wide epidemiology of pediatric IBD in BC and impact on health care utilization, comparing the results with the established BC Children's Hospital (BCCH) IBD registry. We hypothesized that pediatric IBD is increasing and associated with increased health utilization and burden. Methods: All patients registered as being entitled to receive health related services in BC between 1994 and 2008 were eligible for study. IBD cases were identified using a combination of IBD-coded physician encounters and hospitalizations. Age and gender standardized incidence and prevalence rates were calculated and fitted to Poisson regression models. Trends of utilization outcomes such as rates of utilization of specialist, general practitioner, hospital IBD-related services and IBD-related medications were determined over time using bootstrap resampling. Results: The overall incidence of IBD increased from 4.7 (95% CI 4.4 – 4.9) in 1994 to 5.7 (95% CI 5.5 – 6.0) per 100, 000 children in 2008; lower than the incidence of the BCCH cohort which increased from 4.3 to 9.6 per 100, 000. Children aged 10–17 had the highest and greatest rise in incidence. Overall, the hospital days-of-stay rate for IBD-related stays was 5.2 times greater than for non-IBD-related stays (95%CI 3.7 – 7.0), higher in older children. Older children also had 35% more IBD-related outpatient physician visits PPY (95%CI 2% – 79%) than younger children. However, there was a decrease in the rate of IBD-related physician visits from 1996–98 to 2006–08 of almost 1 visit per person year (0.94; 95%CI: 0.5 – 1.4). Finally, we explored the efficacy of using prescription records to better identify IBD cases. The most stringent definition identified a net potential increase of 313 cases, a 28% gain. Conclusions: Though pediatric IBD and associated health care utilization are increasing in BC, we identify limitations of applying province-specific case definitions and propose further investigation. Funding Agencies: Lutsky Foundation and Child and Family Research Institute