HEALTH CARE UTILIZATION DIFFERENCES BETWEEN FIRST NATIONS AND THE GENERAL POPULATION WITH INFLAMMATORY BOWEL DISEASE IN SASKATCHEWAN
Notice bibliographique
Résumé
Background: Indigenous patients with inflammatory bowel disease (IBD) have expressed concerns about barriers to access IBD care. The limited evidence of IBD among Indigenous people highlights the need for studies evaluating access to IBD care in this population. Aim: This study aimed to compare health care utilization between First Nations and the general population diagnosed with IBD in Saskatchewan. Methods: A population-based retrospective cohort study was conducted using administrative health databases of Saskatchewan from 1998 to 2017 fiscal years. As a patient-oriented research initiative, outcomes of interest were chosen in collaboration with Indigenous patients and family advocates (Indigenous individuals living with IBD and family members of an Indigenous person with the disease). A validated algorithm requiring multiple health care contacts was applied to identify incident IBD cases. The self-declared First Nations status variable was used to divide IBD cases between First Nations and the general population. A 1:5 age and sex matching was applied. Cox-proportional models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CI). Results: A matched cohort with 696 IBD incident cases was created (First Nations=116, general population=580). Comparing health care utilization of First Nations and individuals from the general population with IBD, there were no statistically significant differences in outpatient gastroenterology visits (First Nations=81.0%, general population=83.6%; HR=1.13, 95% CI: 0.90-1.41), colonoscopies (First Nations=91.4%, general population=86.9%; HR=1.14, 95% CI: 0.92-1.41), and surgeries for IBD (First Nations =31.0%, general population=33.5%; HR=1.14, 95% CI: 0.80-1.64). In contrast, adjusting by rural or urban residence at the date of diagnosis and diagnostic type, differences between the groups were observed for any IBD medication claim (First Nations=79.3%, general population=89.3%; HR=0.52, 95% CI: 0.41-0.65), 5-ASA claims (First Nations=75.9%, general population=81.4%; HR=0.56, 95% CI: 0.45-0.71), and IBD-specific (First Nations=54.3%, general population=49.3%; HR=1.33, 95% CI: 1.01-1.75) and IBD-related hospitalizations (First Nations=63.8%, general population=52.8%; HR=1.55, 95% CI: 1.20-2.01). Conclusions: This study identified that First Nations had a higher risk of having an IBD-specific and IBD-related hospitalization compared to individuals IBD from the general population. Additionally, it was found an inverse association between First Nations status and having prescription medication claims for IBD in Saskatchewan. These associations could reflect a barrier to access IBD medications, contributing to a higher risk for IBD-specific or -related hospitalizations in the First Nations group. Multiple confounding variables were considered when evaluating these associations, but it was not possible to control by disease severity. Further studies should continue evaluating access to IBD care, medication use, hospitalization rates, and disease severity among First Nations living with IBD.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».