title: Patterns and Predictors of Long-term Nonuse of Medical Therapy Among Persons with Inflammatory Bowel Disease.
abstract: BACKGROUND
  To evaluate patterns and predictors of long-term nonuse of inflammatory bowel disease (IBD)-specific medications among patients with IBD.
  
  
  METHODS
  All incident cases of IBD diagnosed between 1987 and 2012 were identified from the population-based University of Manitoba IBD Epidemiology Database. Point prevalence of long-term medication nonuse (defined as no receipt of IBD-specific medications for a year or longer) was determined over calendar time and the course of disease. Cox proportional hazard regression analysis was performed to identify factors associated with delayed initiation and with becoming a long-term nonuser.
  
  
  RESULTS
  Among 6451 persons with IBD followed since 1987 (46.8% male, 47.8% with Crohn's disease), 11.7% were not dispensed an IBD-specific medication within the first year and 6.2% within 5 years after diagnosis. Factors associated with delayed initiation included having Crohn's disease (hazard ratio [HR] = 0.78, 95% confidence interval [CI], 0.73-0.83), lower socioeconomic status (HR = 0.91, 95% CI, 0.84-0.98), age more than 65 years (HR = 0.76, 95% CI, 0.67-0.86), and having any medical comorbidity. The prevalence of long-term nonuse consistently remained between 40% and 50% of persons with IBD across the study years. Patients with Crohn's disease (HR = 1.14, 95% CI, 1.04-1.25), lower socioeconomic status (HR = 1.14, 95% CI, 1.02-1.27), patients with IBD-associated surgery (HR = 1.72, 95% CI, 1.51-1.96), or delayed initiation of first IBD medication were more likely to become long-term nonusers after initiation.
  
  
  CONCLUSIONS
  At any given time, roughly half of all patients with IBD have not used IBD-specific medications in the previous year. Further work is required to evaluate the clinical implications of long-term medication nonuse in IBD.
authors.affiliation: *Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada; and †Section of Gastroenterology, Department of Internal Medicine, IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Dessalegn Y
authors.initials: DY
authors.lastname: Melesse
authors.forename: Laura E
authors.initials: LE
authors.lastname: Targownik
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.forename: James F
authors.initials: JF
authors.lastname: Blanchard
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D055815:Young Adult