Shifting healthcare use from hospitalizations and surgeries to outpatient visits in children with inflammatory bowel disease: a population-based cohort study from Ontario, Canada

Background — Modern, specialized care for children with inflammatory bowel disease (IBD) may have resulted in changes in health services utilization. We report trends over time in health services utilization and surgery for children with IBD and children without IBD.

Methods — Children diagnosed with IBD <18y between 1994-2013 (n=5518), followed until 2015, in Ontario, Canada were identified from health administrative data, and matched to children without IBD on age, sex, rural/urban household, and income (n=26,677). We report the annual percentage change (APC) with 95% confidence intervals (CI) in the rate of outpatient visits, emergency department (ED) visits, and hospitalizations using negative binomial regression for events within 5 years from the diagnosis/index date. We used Cox proportional hazards regression models to report APC in hazards of intestinal resection (Crohn's disease; CD) and colectomy (ulcerative colitis; UC).

Results — IBD-specific hospitalization rates decreased by 2.5% (95% CI 1.8-3.2%) annually, and all-cause hospitalization rates in children without IBD decreased by 4.3% (95% CI 3.5-5.1%) annually. Intestinal resection risk in CD decreased by 6.0% (95% CI 4.6-7.3%) annually and colectomy risk in UC decreased by 3.0% (95% CI 0.7-5.2%) annually. In contrast, IBD-specific outpatient visit rates increased after 2005 by 4.0% (95% CI 3.1-4.9%) annually. Similar trends in outpatient visits were not observed in children without IBD.

Conclusions — Hospitalizations and surgeries decreased over time while outpatient visits increased after 2005. Decreasing hospitalizations were mirrored in children without IBD, likely resulting from a combination of changes in disease management and health system factors.