Outcomes of pediatric inflammatory bowel disease: socioeconomic status disparity in a universal-access healthcare system

Abstract

Objective: To examine healthcare utilization according to family income in children with inflammatory bowel disease (IBD).

Study design: A population-based cohort of children aged <18 years diagnosed with IBD between 1994 and 2004 was followed using health administrative data. Multivariate models were used to test the association between mean neighborhood income quintile and physician and emergency department visits, hospitalizations, or surgeries.

Results: Compared with children from higher-income neighborhoods, children from low-income neighborhoods were more likely to be hospitalized at least once (hazard ratio, 1.17; 95% CI, 1.05 to 1.30) or to visit the emergency department (hazard ratio, 1.21; 95% CI, 1.09 to 1.35), and had more IBD-related physician visits (OR, 3.73; 95% CI, 1.05 to 13.27). Children from low-income neighborhoods with Crohn's disease (but not those with ulcerative colitis) were more likely to undergo intra-abdominal surgery within 3 years of diagnosis (OR, 1.22; 95% CI, 1.01 to 1.49), especially when diagnosed after 2000 (OR, 1.79; 95% CI, 1.27 to 2.53).

Conclusions: Lower income was associated with a higher rate of health services utilization in children with IBD and with a greater risk of surgery in children with Crohn's disease.