Ma C¹, Smith M², Guizzetti L³, Panaccione R⁴, Kaplan GG⁵, Novak KL⁴, Lu C⁴, Khanna R⁶, Feagan BG⁷, Singh S⁸, Jairath V⁷, Ananthakrishnan AN⁹. Clin Gastroenterol Hepatol. 2020 Jan 24. pii: S1542-3565(20)30102-6. doi: 10.1016/j.cgh.2020.01.023. [Epub ahead of print]

Author information

1 Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada; Robarts Clinical Trials, Inc., London, Ontario, Canada. Electronic address: christopher.ma@ucalgary.ca.

2 Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.

3 Robarts Clinical Trials, Inc., London, Ontario, Canada.

4 Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada.

5 Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

6 Division of Gastroenterology, Western University, London, Ontario, Canada.

7 Robarts Clinical Trials, Inc., London, Ontario, Canada; Division of Gastroenterology, Western University, London, Ontario, Canada; Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada.

8 Division of Gastroenterology, University of California San Diego, La Jolla, California, United States.

9 Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, United States. Electronic address: aananthakrishnan@mgh.harvard.edu.

Abstract

BACKGROUND: Patients with inflammatory bowel diseases (IBD) require repeated healthcare encounters, although the focus of care differs when patients are seen in ambulatory, emergency department (ED), or inpatient settings. We examined contemporary trends and disparities in IBD-related healthcare visits.

METHODS: We used data from the National Ambulatory Medical Care Survey, Nationwide Emergency Department Sample, and National Inpatient Sample to estimate the total number of annual IBD-related visits from 2005 through 2016. We performed logistic regression analyses to test temporal linear trends. Slope and differences in distributions of patient demographics were compared across time and treatment settings.

RESULTS: From 2005 through 2016, approximately 2.2 million IBD-related ambulatory visits (95 CI, 1.9-2.5 million IBD-related ambulatory visits) occurred annually on average, increasing by 70.3% from the time period of 2005-2007 through the time period of 2008-2010, and decreasing by 19.8% from the time period of 2011-2013 through the time period of 2014-2016. An average of 115,934 IBD-related ED visits (95% CI, 113,758-118,111 IBD-related ED visits) and 89,111 IBD-related hospital discharges (95% CI, 87,416-90,807 IBD-related hospital discharges) occurred annually. Significant increases in the rate of IBD-related ED visits (3.2 visits/10,000 encounters, P<.0001) and hospital discharges (6.0 discharges/10,000 encounters, P<.0001) were observed from 2005 through 2016. The proportion of patients paying with private insurance decreased from 2005 through 2016, among all care settings. A greater proportion of young patients, patients with Crohn's disease, non-white patients, and patients with Medicare or Medicaid used hospital-based vs ambulatory services.

CONCLUSIONS: In an analysis of data from 3 large databases, we found that although IBD-related ambulatory visits stabilized-to-decreased from 2005 through 2016, rates of ED use and admission to the hospital have continued to increase with changes in patient demographics, over time and among care settings.