Table 4.
Results of multilevel regression analyses assessing IBD-specific emergency department visits and hospitalizations within 1 and 5 years of IBD diagnosis
| Emergency department Visitsa | Hospitalizationsa | |||||||
|---|---|---|---|---|---|---|---|---|
| Within 1 year of diagnosis | Within 5 years of diagnosis | Within 1 year of diagnosis | Within 5 years of diagnosis | |||||
| Model A | Model B | Model A | Model B | Model A | Model B | Model A | Model B | |
| Utilization of and access to specialist care, OR (95% CI) | ||||||||
| Gastroenterologist as the primary provider of IBD care at diagnosis | 1.01 (0.81, 1.28) | 1.02 (0.81, 1.28) | 1.04 (0.87, 1.24) | 1.05 (0.88, 1.26) | 0.92 (0.76, 1.12) | 0.91 (0.75, 1.11) | 1.03 (0.87, 1.22) | 1.01 (0.85, 1.2) |
| Distance to primary provider of IBD care (per 10 km) | 1.00 (0.98, 1.02) | 1.00 (0.98, 1.02) | 1.00 (0.98, 1.01) | 1.00 (0.98, 1.01) | 1.00 (0.98, 1.02) | 1.00 (0.98, 1.02) | 1.00 (0.99, 1.02) | 1.00 (0.99, 1.02) |
| Emergency department visit at diagnosis | 2.26 (1.77, 2.89) | 2.26 (1.77, 2.89) | 1.60 (1.30, 1.97) | 1.60 (1.30, 1.96) | 0.93 (0.75, 1.17) | 0.93 (0.75, 1.17) | 1.05 (0.86, 1.29) | 1.06 (0.86, 1.29) |
| Hospitalization at diagnosis | 2.18 (1.70, 2.79) | 2.17 (1.70, 2.79) | 1.93 (1.57, 2.39) | 1.94 (1.57, 2.40) | 10.36 (8.33, 12.9) | 10.35 (8.32, 12.89) | 3.97 (3.24, 4.86) | 3.94 (3.22, 4.83) |
| Medication utilization, OR (95% CI) | ||||||||
| Biologic use | 0.69 (0.27, 1.81) | 0.69 (0.26, 1.80) | 2.99 (1.01, 8.85) | 2.97 (1.004, 8.81) | 1.30 (0.81, 2.07) | 1.29 (0.81, 2.05) | 3.73 (1.98, 7.04) | 3.67 (1.95, 6.94) |
| Immunomodulator use | 3.56 (2.52, 5.03) | 3.56 (2.52, 5.03) | 14.74 (10.51, 20.67) | 14.68 (10.46, 20.59) | 6.77 (5.28, 8.68) | 6.79 (5.30, 8.70) | 12.84 (9.82, 16.78) | 12.9 (9.86, 16.86) |
| Time to diagnosis, OR (95% CI) | ||||||||
| <1 month (reference) | ||||||||
| 1 to <6 months | 1.25 (0.81, 1.92) | 1.25 (0.81, 1.92) | 1.33 (0.96, 1.85) | 1.33 (0.96, 1.85) | 1.11 (0.76, 1.62) | 1.11 (0.76, 1.62) | 0.90 (0.65, 1.25) | 0.90 (0.65, 1.25) |
| 6 to <12 months | 1.66 (1.05, 2.61) | 1.66 (1.05, 2.61) | 1.11 (0.75, 1.65) | 1.11 (0.75, 1.65) | 1.16 (0.74, 1.82) | 1.16 (0.74, 1.81) | 0.84 (0.56, 1.25) | 0.84 (0.56, 1.25) |
| ≥12 months | 1.07 (0.85, 1.35) | 1.07 (0.85, 1.35) | 1.11 (0.92, 1.33) | 1.11 (0.93, 1.33) | 1.06 (0.87, 1.29) | 1.06 (0.87, 1.28) | 1.03 (0.87, 1.22) | 1.02 (0.86, 1.21) |
| Number of gastroenterologists per 100,000, OR (95% CI) | ||||||||
| 0–2.4 | 1.01 (0.76, 1.33) | 1.09 (0.90, 1.32) | 0.89 (0.72, 1.09) | 0.82 (0.69, 0.98) | ||||
| 2.5–4.9 | 0.95 (0.68, 1.32) | 0.92 (0.73, 1.15) | 1.03 (0.81, 1.31) | 0.97 (0.79, 1.20) | ||||
| ≥5 (reference) | ||||||||
| Variance of random effects | ||||||||
| Variance ( ) | 0.0500 | 0.0500 | 0.004 | 0.0005 | 0 | 0 | 0 | 0 |
| P-value | 0.1123 | 0.1110 | 0.4221 | 0.49 | - | - | - | - |
| MOR (95% CI) | 1.24 | 1.24 | 1.06 | 1.02 | 1.0 | 1.0 | 1.0 | 1.0 |
| ICC | 0.0153 | 0.0153 | 0.0013 | 0.0001 | 0 | 0 | 0 | 0 |
aEmergency department visits and hospitalizations occurring within 1 month of diagnosis were excluded from the 1- and 5-year outcomes.
CI, confidence interval; IBD, inflammatory bowel disease; ICC, intraclass correlation coefficient; MOR, median odds ratio; OR, odds ratio Model A includes patient-level variables only. Model B includes patient-level variables and network-level gastroenterologist supply. Both models are adjusted for age at IBD diagnosis, sex, mean neighbourhood income quintile, rural/urban residence and comorbidity index. Significant findings are indicated in bold font.