McLaughlin Joi F, Linville Tiffany, Jester Traci W, Marciano Tuvia A, Lazare Farrah, Dotson Jennifer L, Samson Charles, Niklinska-Schirtz Barbara, Cabrera Jose, Leibowtiz Ian, Batra Suruchi, Ammoury Rana, Strople Jennifer A, Saeed Shehzad, Sandberg Kelly C, Tung Jeanne, Verstraete Sofia G, Cox Ryan F, Na Sera, Steiner Steven J, Ali Sabina A, Israel Esther J, Dorsey Jill, Adler Jeremy, Rekhtman Yuliya, Egberg Matthew D, Waduge Emmala Ryan, Savas Jen, Brensinger Colleen M, Lewis James D, Kappelman Michael D
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Division of Pediatric Gastroenterology, Levine Children's Hospital, Charlotte, North Carolina.
Clin Gastroenterol Hepatol. 2025 Apr;23(5):825-834. doi: 10.1016/j.cgh.2024.07.027. Epub 2024 Aug 23.
BACKGROUND & AIMS: Delayed diagnosis of inflammatory bowel disease (IBD) leads to prolonged symptoms and worse long-term outcomes. We sought to evaluate whether race, ethnicity, disease type, and social factors are associated with delayed diagnosis of pediatric IBD.
We performed a cross-sectional study of newly diagnosed pediatric patients with IBD at 22 United States sites from 2019 to 2022. Parents/guardians reported race, ethnicity, time between symptom onset and diagnosis, and other social determinants of health. Through bivariate and multivariable analyses using generalized estimating equations, we evaluated associations between these factors and diagnosis time defined as ≤60 days, 61 to 180 days, 181 to 365 days, and >365 days.
We enrolled 869 participants (mean age at diagnosis, 13.1 years; 52% male; 57% Crohn's disease [CD]; 34% ulcerative colitis [UC]; 8% Hispanic; 30% non-White). Overall, the mean time to diagnosis was 265.9 days. After adjustment, factors associated with longer diagnosis time included CD vs UC (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.9-3.5), 2 or more other health conditions (OR, 1.7; 95% CI, 1.1-2.7), and longer travel time to clinic (>1 hour [OR, 1.7; 95% CI, 1.2-2.4], >2 hours (OR, 1.8; 95% CI, 1.2-2.9] each vs <30 minutes). There was no association with race, ethnicity, birth country, gender, parent education, household income, insurance type, health literacy, and health system distrust.
Consistent with prior literature, diagnostic delay is longer for CD than UC. Reassuringly, time to diagnosis is equitable across racioethnic groups. New models of diagnostic care are needed for communities affected by longer travel times.
炎症性肠病（IBD）的延迟诊断会导致症状持续时间延长和长期预后变差。我们旨在评估种族、民族、疾病类型和社会因素是否与儿童IBD的延迟诊断相关。
我们对2019年至2022年在美国22个地点新诊断的儿童IBD患者进行了一项横断面研究。父母/监护人报告了种族、民族、症状出现至诊断的时间以及其他健康的社会决定因素。通过使用广义估计方程的双变量和多变量分析，我们评估了这些因素与诊断时间（定义为≤60天、61至180天、181至365天和>365天）之间的关联。
我们纳入了869名参与者（诊断时的平均年龄为13.1岁；52%为男性；57%为克罗恩病[CD]；34%为溃疡性结肠炎[UC]；8%为西班牙裔；30%为非白人）。总体而言，平均诊断时间为265.9天。调整后，与诊断时间较长相关的因素包括CD与UC相比（优势比[OR]，2.6；95%置信区间[CI]，1.9 - 3.5）、存在2种或更多其他健康状况（OR，1.7；95% CI，1.1 - 2.7）以及前往诊所的时间较长（>1小时[OR，1.7；95% CI，1.2 - 2.4]、>2小时[OR，1.8；95% CI，1.2 - 2.9]，均与<30分钟相比）。与种族、民族、出生国家、性别、父母教育程度、家庭收入、保险类型、健康素养和对医疗系统的不信任无关。
与先前的文献一致，CD的诊断延迟比UC更长。令人欣慰的是，不同种族/民族群体的诊断时间是公平的。对于受出行时间较长影响的社区，需要新的诊断护理模式。
