Table 6.
Results of multilevel regression analyses assessing medication utilization in patients with IBD within 1 and 5 years of IBD diagnosis
| Immunomodulators | Biologics | Systemic steroids | Chronic opioid use | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Within 1 year of diagnosis | Within 5 years of diagnosis | Within 1 year of diagnosis | Within 5 years of diagnosis | 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 | 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 | 1.99 (1.58, 2.51) | 2.00 (1.59, 2.53) | 1.69 (1.41, 2.02) | 1.70 (1.42, 2.04) | 1.36 (0.79, 2.34) | 1.29 (0.75, 2.21) | 1.59 (1.12, 2.26) | 1.56 (1.10, 2.22) | 1.26 (1.09, 1.46) | 1.27 (1.10, 1.47) | 1.18 (1.01, 1.37) | 1.19 (1.02, 1.39) | 0.70 (0.56, 0.86) | 0.70 (0.57, 0.87) | 0.70 (0.55, 0.89) | 0.70 (0.55, 0.90) |
| Distance to primary provider of IBD care (per 10 km) | 1.01 (0.99, 1.02) | 1.01 (0.99, 1.02) | 1.01 (0.99, 1.02) | 1.01 (0.99, 1.02) | 1.01 (0.98, 1.04) | 1.01 (0.97, 1.04) | 1.02 (0.997, 1.03) | 1.01 (0.996, 1.03) | 1.00 (0.99, 1.01) | 1.00 (0.99, 1.01) | 1.01 (0.99, 1.02) | 1.01 (0.99, 1.02) | 1.00 (0.98, 1.02) | 1.00 (0.98, 1.02) | 1.00 (0.97, 1.02) | 1.00 (0.97, 1.02) |
| Emergency department visit at diagnosis | 1.39 (1.10, 1.75) | 1.39 (1.10, 1.75) | 1.34 (1.10, 1.64) | 1.34 (1.10, 1.64) | 1.38 (0.79, 2.4) | 1.37 (0.79, 2.39) | 1.52 (1.06, 2.19) | 1.52 (1.06, 2.19) | 1.46 (1.24, 1.71) | 1.45 (1.23, 1.71) | 1.29 (1.07, 1.55) | 1.29 (1.07, 1.55) | 0.86 (0.66, 1.12) | 0.86 (0.66, 1.12) | 0.99 (0.73, 1.33) | 0.99 (0.73, 1.33) |
| Hospitalization at diagnosis | 1.55 (1.22, 1.97) | 1.55 (1.22, 1.96) | 1.31 (1.07, 1.62) | 1.31 (1.07, 1.62) | 3.47 (2.00, 6.02) | 3.47 (2.00, 6.01) | 1.54 (1.06, 2.23) | 1.53 (1.05, 2.22) | 2.75 (2.31, 3.27) | 2.76 (2.32, 3.28) | 1.99 (1.62, 2.44) | 2.00 (1.63, 2.45) | 1.32 (1.02, 1.73) | 1.33 (1.02, 1.73) | 1.19 (0.87, 1.61) | 1.19 (0.88, 1.62) |
| Time to diagnosis, OR (95% CI) | ||||||||||||||||
| <1 month (reference) | ||||||||||||||||
| 1 to <6 months | 1.18 (0.81, 1.72) | 1.19 (0.81, 1.72) | 0.98 (0.72, 1.34) | 0.98 (0.72, 1.34) | 1.31 (0.54, 3.15) | 1.33 (0.55, 3.21) | 0.96 (0.53, 1.75) | 0.96 (0.53, 1.75) | 0.91 (0.70, 1.19) | 0.91 (0.70, 1.19) | 0.63 (0.48, 0.82) | 0.63 (0.48, 0.82) | 0.99 (0.63, 1.55) | 0.99 (0.63, 1.55) | 1.34 (0.86, 2.07) | 1.34 (0.86, 2.07) |
| 6 to <12 months | 1.31 (0.86, 1.98) | 1.31 (0.86, 1.98) | 1.06 (0.74, 1.51) | 1.06 (0.74, 1.51) | 0.59 (0.14, 2.5) | 0.59 (0.14, 2.5) | 1.2 (0.62, 2.3) | 1.2 (0.62, 2.3) | 1.09 (0.81, 1.49) | 1.09 (0.81, 1.49) | 0.84 (0.61, 1.16) | 0.84 (0.61, 1.16) | 1.08 (0.66, 1.77) | 1.08 (0.66, 1.77) | 0.78 (0.42, 1.45) | 0.78 (0.42, 1.45) |
| ≥12 months | 1.01 (0.91, 1.35) | 1.11 (0.91, 1.35) | 1.13 (0.96, 1.33) | 1.13 (0.96, 1.33) | 1.01 (0.61, 1.67) | 0.98 (0.59, 1.63) | 1.03 (0.75, 1.42) | 1.02 (0.74, 1.41) | 0.99 (0.87, 1.14) | 1.00 (0.87, 1.14) | 1.06 (0.91, 1.22) | 1.06 (0.92, 1.23) | 1.19 (0.96, 1.48) | 1.19 (0.96, 1.48) | 1.21 (0.94, 1.55) | 1.21 (0.94, 1.55) |
| Number of gastro- enterologists per 100,000, OR (95% CI) | ||||||||||||||||
| 0–2.4 | 1.07 (0.76, 1.51) | 1.11 (0.83, 1.49) | 0.50 (0.28, 0.89) | 0.78 (0.55, 1.10) | 1.20 (0.99, 1.45) | 1.2 (0.97, 1.48) | 1.06 (0.82, 1.37) | 1.12 (0.82, 1.51) | ||||||||
| 2.5–4.9 | 0.9 (0.59, 1.39) | 1.00 (0.70, 1.44) | 0.64 (0.33, 1.24) | 0.88 (0.59, 1.30) | 1.18 (0.94, 1.47) | 1.1 (0.85, 1.41) | 0.94 (0.69, 1.28) | 1.04 (0.73, 1.49) | ||||||||
| ≥5 (reference) | ||||||||||||||||
| Variance of Random Effects | ||||||||||||||||
| Variance ( ) | 0.21 | 0.21 | 0.16 | 0.16 | 0.23 | 0.12 | 0.04 | 0.02 | 0.04 | 0.04 | 0.06 | 0.06 | 0.03 | 0.03 | 0.05 | 0.05 |
| p-value | 0.001 | 0.001 | 0.0011 | 0.0012 | 0.0952 | 0.2185 | 0.2511 | 0.3394 | 0.0095 | 0.0091 | 0.0061 | 0.0056 | 0.2064 | 0.2077 | 0.1505 | 0.1429 |
| MOR | 1.55 | 1.55 | 1.47 | 1.46 | 1.58 | 1.40 | 1.20 | 1.15 | 1.21 | 1.20 | 1.26 | 1.26 | 1.18 | 1.18 | 1.24 | 1.25 |
| ICC | 0.0610 | 0.0601 | 0.0474 | 0.0461 | 0.0655 | 0.0362 | 0.0107 | 0.0063 | 0.0120 | 0.0114 | 0.0174 | 0.0170 | 0.0092 | 0.0091 | 0.0153 | 0.0159 |
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.