Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Inflamm Bowel Dis. 2021 Aug 19;27(9):1462-1474. doi: 10.1093/ibd/izaa310.
Inflammatory bowel disease (IBD) is associated with an increase in psychiatric comorbidity (PC) compared with the general population. We aimed to determine the impact of PC on health care utilization in persons with IBD.
We applied a validated administrative definition of IBD to identify all Manitobans with IBD from April 1, 2006, to March 31, 2016, and a matched cohort without IBD. A validated definition for PC in IBD population was applied to both cohorts; active PC status meant ≥2 visits for psychiatric diagnoses within a given year. We examined the association of active PC with physician visits, inpatient hospital days, proportion with inpatient hospitalization, and use of prescription IBD medications in the following year. We tested for the presence of a 2-way interaction between cohort and PC status.
Our study matched 8459 persons with IBD to 40,375 controls. On crude analysis, IBD subjects had ≥3.7 additional physician visits, had >1.5 extra hospital days, and used 2.1 more drug types annually than controls. Subjects with active PC had >10 more physician visits, had 3.1 more hospital days, and used >6.3 more drugs. There was a synergistic effect of IBD (vs no IBD) and PC (vs no PC) across psychiatric disorders of around 4%. This synergistic effect was greatest for anxiety (6% [2%, 9%]). After excluding psychiatry-related visits and psychiatry-related hospital stays, there remained an excess health care utilization in persons with IBD and PC.
Inflammatory bowel disease with PC increases health care utilization compared with matched controls and compared with persons with IBD without PC. Active PC further increases health care utilization.
与普通人群相比，炎症性肠病（IBD）患者的精神共病（PC）发病率更高。本研究旨在确定 PC 对 IBD 患者医疗保健利用的影响。
我们应用了一种经过验证的行政定义来确定 2006 年 4 月 1 日至 2016 年 3 月 31 日期间所有曼尼托巴省的 IBD 患者，并对其匹配了一个没有 IBD 的对照组。我们对两个队列均应用了一个经过验证的 IBD 患者 PC 定义；在给定的一年内，出现≥2 次精神科诊断就诊即被认为患有活动性 PC。我们检测了活动性 PC 与以下一年内的医生就诊次数、住院天数、住院比例和 IBD 处方药物使用情况之间的关联。我们检测了队列和 PC 状态之间是否存在双向相互作用。
我们的研究将 8459 名 IBD 患者与 40375 名对照进行了匹配。在未经校正的分析中，IBD 患者的医生就诊次数多 3.7 次，住院天数多 1.5 天，每年使用的药物种类多 2.1 种。患有活动性 PC 的患者的医生就诊次数多 10 次，住院天数多 3.1 天，使用的药物种类多 6.3 种。IBD（与无 IBD 相比）和 PC（与无 PC 相比）之间的精神障碍存在约 4%的协同作用。这种协同作用在焦虑症中最大（6%[2%，9%]）。在排除与精神病学相关的就诊和与精神病学相关的住院治疗后，患有 IBD 和 PC 的患者的医疗保健利用率仍然过高。
与匹配对照组和无 PC 的 IBD 患者相比，患有 PC 的 IBD 患者的医疗保健利用率增加。活动性 PC 进一步增加了医疗保健利用率。
