A31 DISPARITIES IN THE CARE OF RURAL AND URBAN CANADIANS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED STUDY
Bibliographic record
Abstract
Canada’s large geographic area and low population density poses challenges in access to specialized healthcare for remote and rural residents. Inflammatory bowel disease (IBD) (Crohn’s disease (CD) and ulcerative colitis (UC)) is less common among rural residents, however disparities in care and outcomes may exist. Compare health services use and markers of disease control (hospital admissions and surgeries) in rural and urban IBD patients in Canada using population-based health administrative data. Validated algorithms identified all incident cases of IBD from administrative data in 3 provinces: Alberta (AB) 1999–2008, Manitoba (MB) 1999–2010, Ontario (ON) 1999–2010. We compared rural to urban residents for time to diagnosis, IBD-specific hospitalization, outpatient visits, emergency department (ED) use (ON only), surgical resections (CD) or colectomy (UC), and gastroenterologist (GI) care. Rural/urban status was based on Metropolitan Area and Census Agglomeration Influenced Zones. Multivariable regression compared outcomes in rural/urban residents, controlling for confounders (Table footnote). Provincial results were meta-analyzed to produce overall estimates. See Table. 37,018 urban and 6656 rural residents with incident IBD were included. Rural patients had fewer GI visits, and a smaller proportion of their IBD-specific care provided by GI (39.1% vs 61.4%, P<0.0001). Rural patients were more frequently hospitalized, and used the ED more. There was no difference in outpatient visit rate or risk of first surgery. However, rural patients were more likely to undergo multiple intestinal resections. Rural IBD patients have less use of GI specialists and more need for acute care, suggesting worse outcomes related to disparities in access to specialist care. Innovative methods of delivering GI care to rural IBD patients (such as telehealth, online support, remote clinics) should be explored. Table. IBD-specific health services utilization in rural patients (ref: urban patients) Models adjusted for sex, diagnosis age, income; aCox proportionate hazard; bPoisson; cNegative binomial; dOntario only; eLogistic CIHRJanssen Future Leaders in IBD Grant, CHEO Research Institute
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".