Travel Time to Treating Center is Associated With Diagnostic Delay in Pediatric Inflammatory Bowel Disease.

Autor:	McLaughlin JF; Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: joifmclaughlin@gmail.com., Linville T; Division of Pediatric Gastroenterology, Levine Children's Hospital, Charlotte, North Carolina., Jester TW; Division of Pediatric Gastroenterology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama., Marciano TA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, NYU Langone - Long Island School of Medicine, Mineola, New York., Lazare F; Division of Pediatric Gastroenterology, Hepatology and Nutrition, NYU Long Island, Lake Success, New York., Dotson JL; Division of Pediatric Gastroenterology, Hepatology, and Nutrition; Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, Ohio; The Center for Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio., Samson C; Division of Pediatric Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri., Niklinska-Schirtz B; Division of Pediatric Gastroenterology, Emory University School of Medicine, Atlanta, Georgia., Cabrera J; Division of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin., Leibowtiz I; Division of Pediatric Gastroenterology, Children's National, Washington, DC., Batra S; Division of Pediatric Gastroenterology, Children's National, Washington, DC., Ammoury R; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of the King's Daughter, Norfolk, Virginia., Strople JA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Saeed S; Department of Medical Affairs and Division of Pediatric Gastroenterology, Dayton Children's Hospital, Boonshoft School of Medicine, Wright State University, Dayton, Ohio., Sandberg KC; Division of Pediatric Gastroenterology, Dayton Children's Hospital, Boonshoft School of Medicine, Wright State University, Dayton, Ohio., Tung J; University of Oklahoma Children's Physicians, Pediatric Gastroenterology, Oklahoma City, Oklahoma., Verstraete SG; Division of Pediatric Gastroenterology, UCSF Benioff Children's Hospital San Francisco, San Francisco, California., Cox RF; Division of Pediatric Gastroenterology, Helen DeVos Children's Hospital, Grand Rapids, Michigan., Na S; Division of Pediatric Gastroenterology, Nemours Children's Hospital, Wilmington, Delaware., Steiner SJ; Division of Pediatric Gastroenterology/Hepatology/Nutrition, Indiana University School of Medicine, Indianapolis, Indiana., Ali SA; Division of Pediatric Gastroenterology, UCSF Benioff Children's Hospital Oakland, Oakland, California., Israel EJ; Division of Pediatric Gastroenterology, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Dorsey J; Division of Pediatric Gastroenterology, Nemours Children's Health, Jacksonville, Florida., Adler J; Susan B. Meister Child Health Evaluation and Research Center, Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan., Rekhtman Y; Sanofi-Pasteur, Columbia, South Carolina., Egberg MD; Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Waduge ER; Division of Pediatric Gastroenterology, Atrium Health Levine Children's Hospital, Charlotte, North Carolina., Savas J; ImproveCareNow, Inc, Burlington, Vermont., Brensinger CM; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Lewis JD; Division of Gastroenterology and Hepatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Kappelman MD; Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2024 Aug 23. Date of Electronic Publication: 2024 Aug 23.
DOI:	10.1016/j.cgh.2024.07.027
Abstrakt:	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. Methods: 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. Results: 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, sex, parent education, household income, insurance type, health literacy, and health system distrust. Conclusions: 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. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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