Low income children with Inflammatory Bowel Disease have higher surgical and hospitalization rates in a Universal Health Care System

Abstract

Canada's single-payer health system provides all residents of Ontario, Canada's largest province, with publicly-funded healthcare. Nonetheless, previous studies have demonstrated income-based disparities in health services utilization and outcomes in children with chronic diseases. To test whether there are important differences in healthcare utilization and outcomes based on household income in children with IBD. The Ontario Crohn's and Colitis Cohort uses a validated algorithm to identify all children <18 years diagnosed 1994-2004 with IBD within Ontario's health administrative databases. Children were followed until 2008. Patients were grouped into census-based mean neighborhood income quintiles groupings: the lowest two income quintiles (n= 944) and highest two income quintiles (n= 1286). Multivariable models tested the association between income group and physician and emergency department (ED) visits, hospitalizations, or surgery. Logistic, linear or Cox proportional hazard regression models were used. Covariates were determined a priori (sex, diagnosis age) or included if they changed the estimate of the income group variable by ≥10% (incidence date, rurality at birth and at diagnosis). 2230 IBD patients were included (age at diagnosis 14.4±3.9y, follow-up 8.4±3.2y [range 3-14y]). Care providers (adult/pediatric gastroenterologists, surgeons) were similar between groups. Lower income children were more likely to be hospitalized or visit the ED and had more physician IBD-related visits (see Table). Lower income children with Crohn's (not UC) were more likely to undergo surgery within 3y of diagnosis. IBD-RELATED HEALTH SERVICES UTILIZATION BY NEIGHBORHOOD INCOME QUINTILE GROUP. IBD-RELATED HEALTH SERVICES UTILIZATION BY NEIGHBORHOOD INCOME QUINTILE GROUP. In the context of higher overall physician visits in low income children with IBD, higher surgical rates in those with Crohn's disease, and higher hospitalization rates in all children with IBD are likely due to factors other than access to healthcare services. Further work should delineate whether there are potentially modifiable risk factors associated with these worse health outcomes in children of lower income families.