Peña-Sánchez Juan Nicolás, Osei Jessica Amankwah, Rohatinsky Noelle, Lu Xinya, Risling Tracie, Boyd Ian, Wicks Kendall, Wicks Mike, Quintin Carol-Lynne, Dickson Alyssa, Fowler Sharyle A
Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada.
College of Nursing, University of Saskatchewan, Canada.
J Can Assoc Gastroenterol. 2022 May 14;6(2):55-63. doi: 10.1093/jcag/gwac015. eCollection 2023 Apr.
Rural dwellers with inflammatory bowel disease (IBD) face barriers to accessing specialized health services. We aimed to contrast health care utilization between rural and urban residents diagnosed with IBD in Saskatchewan, Canada.
We completed a population-based retrospective study from 1998/1999 to 2017/2018 using administrative health databases. A validated algorithm was used to identify incident IBD cases aged 18+. Rural/urban residence was assigned at IBD diagnosis. Outpatient (gastroenterology visits, lower endoscopies, and IBD medications claims) and inpatient (IBD-specific and IBD-related hospitalizations, and surgeries for IBD) outcomes were measured after IBD diagnosis. Cox proportional hazard, negative binomial, and logistic models were used to evaluate associations adjusting by sex, age, neighbourhood income quintile, and disease type. Hazard ratios (HR), incidence rate ratios (IRR), odds ratios (OR), and 95% confidence intervals (95% CI) were reported.
From 5,173 incident IBD cases, 1,544 (29.8%) were living in rural Saskatchewan at IBD diagnosis. Compared to urban dwellers, rural residents had fewer gastroenterology visits (HR = 0.82, 95% CI: 0.77-0.88), were less likely to have a gastroenterologist as primary IBD care provider (OR = 0.60, 95% CI: 0.51-0.70), and had lower endoscopies rates (IRR = 0.92, 95% CI: 0.87-0.98) and more 5-aminosalicylic acid claims (HR = 1.10, 95% CI: 1.02-1.18). Rural residents had a higher risk and rates of IBD-specific (HR = 1.23, 95% CI: 1.13-1.34; IRR = 1.22, 95% CI: 1.09-1.37) and IBD-related (HR = 1.20, 95% CI: 1.11-1.31; IRR = 1.23, 95% CI: 1.10-1.37) hospitalizations than their urban counterparts.
We identified rural-urban disparities in IBD health care utilization that reflect rural-urban inequities in the access to IBD care. These inequities require attention to promote health care innovation and equitable management of patients with IBD living in rural areas.
患有炎症性肠病（IBD）的农村居民在获得专科医疗服务方面面临障碍。我们旨在对比加拿大萨斯喀彻温省农村和城市被诊断为IBD的居民的医疗保健利用情况。
我们利用行政卫生数据库完成了一项基于人群的回顾性研究，研究时间为1998/1999年至2017/2018年。使用经过验证的算法识别18岁及以上的IBD确诊病例。在IBD诊断时确定农村/城市居住地。在IBD诊断后测量门诊（胃肠病科就诊、下消化道内镜检查和IBD药物报销）和住院（IBD特异性和IBD相关住院以及IBD手术）结果。使用Cox比例风险模型、负二项式模型和逻辑模型评估经性别、年龄、邻里收入五分位数和疾病类型调整后的关联。报告风险比（HR）、发病率比（IRR）、优势比（OR）和95%置信区间（95%CI）。
在5173例IBD确诊病例中，1544例（29.8%）在IBD诊断时居住在萨斯喀彻温省农村地区。与城市居民相比，农村居民的胃肠病科就诊次数较少（HR = 0.82，95%CI：0.77 - 0.88），以胃肠病学家作为主要IBD护理提供者的可能性较小（OR = 0.60，95%CI：0.51 - （此处原文有误，应为0.70）0.70），下消化道内镜检查率较低（IRR = 0.92，95%CI：0.87 - 0.98），5-氨基水杨酸报销更多（HR = 1.10，95%CI：1.02 - 1.18）。农村居民IBD特异性（HR = 1.23，95%CI：1.13 - 1.34；IRR = 1.22，95%CI：1.09 - 1.37）和IBD相关（HR = 1.20，95%CI：1.11 - 1.31；IRR = 1.23，95%CI：1.10 - 1.37）住院的风险和发生率高于城市居民。
我们发现IBD医疗保健利用方面存在城乡差异，这反映了城乡在获得IBD护理方面的不平等。这些不平等需要引起关注，以促进医疗保健创新和对农村地区IBD患者的公平管理。
