Travel Time to Treating Center is Associated With Diagnostic Delay in Pediatric Inflammatory Bowel Disease

Abstract

Delayed diagnosis of inflammatory bowel disease (IBD) leads to prolonged symptoms and worse long-term outcomes. We sought to evaluate whether race, ethnicity, disease type, and social factors are associated with delayed diagnosis of pediatric IBD. We performed a cross-sectional study of newly diagnosed pediatric patients with IBD at 22 U.S. sites from 2019-2022. Parents/guardians reported race, ethnicity, time between symptom onset and diagnosis, and other social determinants of health. Through bivariate and multivariable analyses using generalized estimating equations we evaluated associations between these factors and diagnosis time defined as ≤60 days, 61-180 days, 181-365 days and >365 days. We enrolled 869 participants (mean age at diagnosis 13.1 years, 52% male, 57% Crohn's disease (CD), 34% ulcerative colitis (UC), 8% Hispanic, 30% non-White). Overall, the mean time to diagnosis was 265.9 days. After adjustment, factors associated with longer diagnosis time included CD vs. UC (OR 2.6, 95% CI 1.9-3.5), 2 or more other health conditions (OR 1.7, 95% CI 1.1-2.7), and longer travel time to clinic [(> 1 hour (OR 1.7, 95% CI 1.2-2.4), > 2 hours (OR 1.8, 95% CI 1.2-2.9) each vs<30 minute]. There was no association with race, ethnicity, birth country, gender, parent education, household income, insurance type, health literacy, and health system distrust. Consistent with prior literature, diagnostic delay is longer for CD than UC. Reassuringly, time to diagnosis is equitable across racioethnic groups. New models of diagnostic care are needed for communities affected by longer travel times.