P629 Rural-urban inequities in Inflammatory Bowel Disease health care access: a population-based retrospective cohort study from a Western Canadian Province

Abstract

Abstract Background Inflammatory bowel disease (IBD) is a chronic digestive condition with significant complications if left untreated. Rural dwellers face barriers to access specialised health care, which is located in larger urban centres. We aimed to contrast health care utilization (outpatient gastroenterology visits, colonoscopies, claims for IBD medications, IBD-specific and IBD-related hospitalizations, and surgeries for IBD) between rural and urban residents diagnosed with IBD in the Canadian province of Saskatchewan (SK). Methods We completed a population-based retrospective study using SK administrative health databases (hospital discharge abstracts, medication claims, and physician billings) between the 1999 to 2016 fiscal years. A validated IBD algorithm requiring multiple health care contacts was used for case ascertainment. IBD incidence cases were identified by requiring eight years of continuous health care coverage without IBD health care contacts before the date of diagnosis. Cases were assigned to a rural or urban location based on their residential postal codes at the date of IBD diagnosis. Study outcomes were measured from IBD diagnosis to the end of the study period or end of health care coverage. Cox proportional regression models were used to evaluate the associations between rural-urban residence and each study outcome. Models were adjusted by sex, age, neighbourhood income quintile at IBD diagnosis, and disease type (Crohn’s disease and ulcerative colitis). Adjusted hazard ratios (HR) and 95% confidence intervals (95%CI) were reported. Results We identified 5,173 IBD incident cases in SK between 1999 and 2016; 1,544 (29.8%) individuals were living in rural locations at the date of diagnosis. Compared to urban dwellers, rural residents had lower gastroenterology visits (HR=0.82, 95%CI 0.77–0.88) and higher 5-aminosalicylic acid (5-ASA) claims (HR=1.10, 95%CI 1.02–1.18). Furthermore, rural residents had a higher risk of IBD-specific (HR=1.23, 95%CI 1.13–1.34) and IBD-related (HR=1.20, 95%CI 1.11–1.31) hospitalizations than their urban counterparts. We did not observe significant rural-urban differences in the access to colonoscopies, biologic and immune modulator therapies, and surgeries for IBD. Conclusion We identified rural-urban disparities in IBD health care access, specifically, lower outpatient gastroenterology visits, higher 5-ASA claims, and a higher risk of hospitalizations for individuals living in rural locations at IBD diagnosis. Our findings reflect rural-urban inequities in the access to IBD care that require the attention of health care providers and decision-makers to promote health care innovation and equitable management of patients with IBD living in rural areas.