Inequities in Rural and Urban Health Care Utilization Among Individuals Diagnosed With Inflammatory Bowel Disease: A Retrospective Population-Based Cohort Study From Saskatchewan, Canada

Abstract

Background Rural dwellers with inflammatory bowel disease (IBD) face barriers to accessing specialized health services. We aimed to contrast health care utilization between rural and urban residents diagnosed with IBD in Saskatchewan, Canada. Methods We completed a population-based retrospective study from 1998/1999 to 2017/2018 using administrative health databases. A validated algorithm was used to identify incident IBD cases aged 18+. Rural/urban residence was assigned at IBD diagnosis. Outpatient (gastroenterology visits, lower endoscopies, and IBD medications claims) and inpatient (IBD-specific and IBD-related hospitalizations, and surgeries for IBD) outcomes were measured after IBD diagnosis. Cox proportional hazard, negative binomial, and logistic models were used to evaluate associations adjusting by sex, age, neighbourhood income quintile, and disease type. Hazard ratios (HR), incidence rate ratios (IRR), odds ratios (OR), and 95% confidence intervals (95% CI) were reported. Results From 5,173 incident IBD cases, 1,544 (29.8%) were living in rural Saskatchewan at IBD diagnosis. Compared to urban dwellers, rural residents had fewer gastroenterology visits (HR = 0.82, 95% CI: 0.77–0.88), were less likely to have a gastroenterologist as primary IBD care provider (OR = 0.60, 95% CI: 0.51–0.70), and had lower endoscopies rates (IRR = 0.92, 95% CI: 0.87–0.98) and more 5-aminosalicylic acid claims (HR = 1.10, 95% CI: 1.02–1.18). Rural residents had a higher risk and rates of IBD-specific (HR = 1.23, 95% CI: 1.13–1.34; IRR = 1.22, 95% CI: 1.09–1.37) and IBD-related (HR = 1.20, 95% CI: 1.11–1.31; IRR = 1.23, 95% CI: 1.10–1.37) hospitalizations than their urban counterparts. Conclusion We identified rural-urban disparities in IBD health care utilization that reflect rural-urban inequities in the access to IBD care. These inequities require attention to promote health care innovation and equitable management of patients with IBD living in rural areas.

Patient and Public Involvement in Inflammatory Bowel Disease Research—A Scoping Review

“…IBD patients and their surrogates also acted as active participants in study recruitment in four studies (7.8%). 15 , 35 , 52 , 65 In one study, patient champions within the project team devised a new method of identifying and transferring IBD patients to specialist nurse-led telephone clinics, which helped boost transfer rates. 30 …”

“…A pair of studies linked to a patient-oriented research initiative achieved a high level of engagement. 52 , 65 One study evaluated perspectives of healthcare use among rural Canadians with IBD. 52 The study engaged patient and family advisors as equal members in decision-making.…”

“…Patient partners contributed to the study design, co-created recruitment materials, reviewed findings, and co-developed the manuscript. 52 , 65 A separate study with high patient engagement compared healthcare utilization between First Nations patients and the general IBD population. This retrospective cohort study involved indigenous patients in study outcome selection, data analysis, and the knowledge-sharing phases of research (wherein 1 advocate co-presented the published work at multiple conferences).…”

Exploring the Experiences of Virtual Inflammatory Bowel Disease Care in Saskatchewan

“…VC technologies can bridge barriers to specialist health care access in communities without such providers (e.g., rural areas) ( Rohatinsky et al, 2021 ). Notably, individuals with IBD residing in rural areas have limited access to GCPs and report more hospitalizations and emergency department visits than those in urban areas ( Benchimol et al, 2018 ; Pena-Sanchez et al, 2023 ). When individuals with IBD are monitored by a GCP and have access to appropriate, efficient care, the potential health system cost savings are significant and include reduced disease-related complications, hospital admissions, and surgeries.…”

The 2023 Impact of Inflammatory Bowel Disease in Canada: Direct Health System and Medication Costs

“…Data from multiple provinces have described differences in healthcare utilization among people with IBD living in rural and urban regions ( 17 , 25 ). People with IBD living in rural regions had more IBD-specific hospitalizations than those in urban regions (Alberta/Ontario/Manitoba combined, incidence rate ratio [IRR]: 1.17; 95% CI: 1.02, 1.34; Saskatchewan, IRR: 1.22; 95% CI: 1.09, 1.37) ( 17 , 25 ).…”