Associations between prior healthcare use, time to diagnosis, and clinical outcomes in inflammatory bowel disease: a nationally representative population-based cohort study.

Autor:	Jayasooriya N; Institute for Infection and Immunity, St George's University of London, London, UK nishani.jayasooriya@nhs.net richard.pollok@nhs.net.; Division of Epidemiology, Public Health and Primary Care, Imperial College London, London, UK., Saxena S; Division of Epidemiology, Public Health and Primary Care, Imperial College London, London, UK., Blackwell J; Edinburgh Inflammatory Bowel Disease, Western General Hospital, Edinburgh, UK., Bottle A; Division of Epidemiology, Public Health and Primary Care, Imperial College London, London, UK., Creese H; Division of Epidemiology, Public Health and Primary Care, Imperial College London, London, UK., Petersen I; Research Department of Primary Care and Population Health, University College London, London, UK., Pollok RCG; Institute for Infection and Immunity, St George's University of London, London, UK nishani.jayasooriya@nhs.net richard.pollok@nhs.net.; Division of Epidemiology, Public Health and Primary Care, Imperial College London, London, UK.; Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK.
Jazyk:	angličtina
Zdroj:	BMJ open gastroenterology [BMJ Open Gastroenterol] 2024 May 27; Vol. 11 (1). Date of Electronic Publication: 2024 May 27.
DOI:	10.1136/bmjgast-2024-001371
Abstrakt:	Background: Timely diagnosis and treatment of inflammatory bowel disease (IBD) may improve clinical outcomes. Objective: Examine associations between time to diagnosis, patterns of prior healthcare use, and clinical outcomes in IBD. Design: Using the Clinical Practice Research Datalink we identified incident cases of Crohn's disease (CD) and ulcerative colitis (UC), diagnosed between January 2003 and May 2016, with a first primary care gastrointestinal consultation during the 3-year period prior to IBD diagnosis. We used multivariable Cox regression to examine the association of primary care consultation frequency (n=1, 2, >2), annual consultation intensity, hospitalisations for gastrointestinal symptoms, and time to diagnosis with a range of key clinical outcomes following diagnosis. Results: We identified 2645 incident IBD cases (CD: 782; UC: 1863). For CD, >2 consultations were associated with intestinal surgery (adjusted HR (aHR)=2.22, 95% CI 1.45 to 3.39) and subsequent CD-related hospitalisation (aHR=1.80, 95% CI 1.29 to 2.50). For UC, >2 consultations were associated with corticosteroid dependency (aHR=1.76, 95% CI 1.28 to 2.41), immunomodulator use (aHR=1.68, 95% CI 1.24 to 2.26), UC-related hospitalisation (aHR=1.43, 95% CI 1.05 to 1.95) and colectomy (aHR=2.01, 95% CI 1.22 to 3.27). For CD, hospitalisation prior to diagnosis was associated with CD-related hospitalisation (aHR=1.30, 95% CI 1.01 to 1.68) and intestinal surgery (aHR=1.71, 95% CI 1.13 to 2.58); for UC, it was associated with immunomodulator use (aHR=1.42, 95% CI 1.11 to 1.81), UC-related hospitalisation (aHR=1.36, 95% CI 1.06 to 1.95) and colectomy (aHR=1.54, 95% CI 1.01 to 2.34). For CD, consultation intensity in the year before diagnosis was associated with CD-related hospitalisation (aHR=1.19, 95% CI 1.12 to 1.28) and intestinal surgery (aHR=1.13, 95% CI 1.03 to 1.23); for UC, it was associated with corticosteroid use (aHR=1.08, 95% CI 1.04 to 1.13), corticosteroid dependency (aHR=1.05, 95% CI 1.00 to 1.11), and UC-related hospitalisation (aHR=1.12, 95% CI 1.03 to 1.21). For CD, time to diagnosis was associated with risk of CD-related hospitalisation (aHR=1.03, 95% CI 1.01 to 1.68); for UC, it was associated with reduced risk of UC-related hospitalisation (aHR=0.83, 95% CI 0.70 to 0.98) and colectomy (aHR=0.59, 95% CI 0.43 to 0.80). Conclusion: Electronic records contain valuable information about patterns of healthcare use that can be used to expedite timely diagnosis and identify aggressive forms of IBD. Competing Interests: Competing interests: RCGP—advisory board for Galapagos; Celltrion educational sponsorship. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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