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P210 Healthcare resources utilisation prior to the diagnosis of ulcerative colitis and Crohn’s disease

Rodríguez-Lago, I.(1);Agirre, U.(2);Intxaurza, N.(2);Cantero, D.(3);Barreiro-de Acosta, M.(4);Cabriada, J.L.(1);

(1)Hospital de Galdakao- Biocruces Bizkaia Health Research Institute, Gastroenterology, Galdakao, Spain;(2)Hospital de Galdakao, Research Unit- Red de Investigación en Servicios de Salud en Enfermedades Crónicas REDISSEC, Galdakao, Spain;(3)Hospital de Galdakao, Quality of Care Unit, Galdakao, Spain;(4)Hospital Clínico Universitario de Santiago de Compostela, Gastroenterology, Santiago de Compostela, Spain

Background

Ulcerative colitis (UC) and Crohn’s disease (CD) are two chronic conditions of the gastrointestinal tract. Previous data suggest that a subclinical inflammatory process precedes the initial symptoms. Our aim was to determine if patients with UC or CD have an increase in healthcare utilization in the years preceding the disease onset.

Methods

A single-centre retrospective case-control study was performed at Hospital de Galdakao (Spain). We included all consecutive patients with a new diagnosis of UC/CD between 01/01/2018 and 31/12/2019. Cases were matched 1:3 with controls adjusted by sex, age and date, excluding those subjects with any visit to Gastroenterology Department. The main outcomes were the number of outpatient or Emergency visits, hospital admissions, radiological examinations (ultrasound, CT, MRI), sick-leaves, and prescriptions (antibiotics, steroids) in the 5 years before the diagnosis of UC/CD. Descriptive statistics were used, followed by chi-square tests and a multivariable hurdle regression model, adjusted by smoking habits and Charlson index, in order to perform a per year analysis. Additional grouped comparisons of the preceding 3 and 5 years were performed, and also excluding the 12 months prior to diagnosis.

Results

A total of 305 cases were included (160 UC, 168 CD; median 48 years; 53% female) and compared with 915 controls. Baseline characteristics including age, smoking habits, and comorbidities were comparable. Grouped analysis (excluding 12 months prior to UC/CD diagnosis) are summarized in Table 1. Patients had an increase in the number of hospital admissions, visits to the Emergency room or Primary Care physician, sick-leaves, radiological examinations, and prescription of antibiotics or corticosteroids in the previous 3 to 5 years, excluding the 12 months prior to diagnosis of UC/CD.

OutcomeInterval prior to diagnosis (years)OR (95% CI)IRR (95% CI)
Hospital admission
-31.54 (1.04, 2.27)1.22 (0.47, 3.13)
-51.56 (1.13, 2.15)1.17 (0.65, 2.13)
Emergency visits
-31.52 (1.16, 1.99)1.22 (0.87, 1.72)
-51.57 (1.20, 2.06)1.29 (0.99, 1.68)
Outpatient visits
-31.32 (0.97, 1.78)1.22 (0.92, 1.63)
-51.18 (0.83, 1.67)1.19 (0.93, 1.52)
Primary care visits
-31.19 (0.92, 1.56)1.36 (1.11, 1.66)
-51.02 (0.78, 1.33)1.44 (1.18, 1.75)
Sick-leaves
-31.33 (0.98, 1.79)1.38 (0.88, 2.16)
-51.26 (0.96, 1.67)1.59 (1.17, 2.16)
Antibiotics
-31.85 (1.22, 2.80)1.19 (0.58, 2.48)
-51.20 (0.83, 1.75)1.77 (1.02, 3.06)
Corticosteroids
-31.44 (0.99, 2.09)0.66 (0.31, 1.38)
-51.51 (1.07, 2.14)0.57 (0.29, 1.11)

Conclusion

Patients with UC and CD show an increased use of healthcare resources in the years prior to the diagnosis. Diagnostic tools should focus in early predictors of disease onset as they may prompt an earlier identification of patients with IBD.

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