title: Health Care Use by a Population-Based Cohort of Children With Inflammatory Bowel Disease.
abstract: OBJECTIVE
  There have been few population-based studies of health care used by children with inflammatory bowel disease (IBD).
  
  
  METHODS
  We identified all children with IBD in the population-based University of Manitoba IBD Epidemiology Database; 651 children with IBD were matched for age, sex, and area of residence with 5950 children without IBD (controls), and followed up for a total of 6419 and 53,875 person-years, respectively. We extracted and analyzed data on IBD type (Crohn's disease vs ulcerative colitis), diagnosis before or after 2002 (era of diagnosis), age, sex, ambulatory care visits and hospitalizations before and after diagnosis, comorbidities, exposure to IBD drugs, and surgeries.
  
  
  RESULTS
  Children with IBD were more likely to have visits for gastrointestinal symptoms in each of the 4 years before IBD diagnosis than controls, with no significant effect of era of diagnosis. Children with IBD had more physician encounters for psychosocial diagnoses in the 6 months before or after the IBD diagnosis, as well as in the second year after IBD diagnosis, than controls; 56% of children with IBD were exposed to corticosteroids within the year after their diagnosis, with no decrease over eras of follow-up evaluation. Among children diagnosed from 2002 through 2010, the 8-year actuarial rate of colectomy for those with ulcerative colitis was 8%, and the rate of resective surgery for Crohn's disease was 10%; both of these values were lower than for children diagnosed from 1987 through 2001.
  
  
  CONCLUSIONS
  In a population-based study from Canada, children with IBD were more likely to have visits for gastrointestinal symptoms in each of the 4 years before IBD diagnosis than children without IBD, indicating a potential delay in diagnosis of this disease. Rates of surgery are decreasing among children with IBD.
authors: IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: harminder.singh@med.umanitoba.ca.
authors: Harminder
authors: H
authors: Singh
authors: IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Department of Epidemiology and Cancer Registry, Winnipeg, Manitoba, Canada.
authors: Zoann
authors: Z
authors: Nugent
authors: IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Laura E
authors: LE
authors: Targownik
authors: Department of Paediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Wael
authors: W
authors: El-Matary
authors: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Marni
authors: M
authors: Brownell
authors: IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Charles N
authors: CN
authors: Bernstein
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008350:Manitoba
keywords: Delayed Diagnosis; Hospitalization; Improving Outcomes; Medication Use; Surgery