DOP75 Surgery and hospitalisations rates in inflammatory bowel disease patients in the Québec provincial database from 199–6 to 2015
Bibliographic record
Abstract
Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are associated with high healthcare expenditures related to medications, hospitalisations, and surgeries. Our aim was to analyse disease outcomes and treatment algorithms in newly diagnosed IBD patients in Québec over the past 2 decades, comparing periods before and after routine public reimbursement of biologics. Overall, 34644 newly diagnosed IBD patients (CD: 20644 or 59.5%; M:F CD: 3:4, UC: 1:1; CD <40 years old: 46% vs. UC<40 years old: 35%) were identified from the population-based health insurance database of Québec from 1996 to 2015. The primary and secondary outcomes included time to and probability of first hospitalisation and first major surgery, and medication exposures. Prescription data were collected from the public prescription database (RAMQ). Probability of major surgery increased after 2010 in CD (at 5 years after diagnosis: before and after 2010: 8% (SD: 0.2%) vs.15% (0.6%); p < 0.0001) and UC patients (6% (0.2%) vs. 10% (0.6%); p < 0.0001). Probability of first major surgery Hospitalisations rates remained unchanged, but were higher in CD compared with UC (p < 0.0001). Probability of first hospitalisation IBD patients on biologicals had overall lower probability of hospitalisations compared with other drug types (overall 5 years probability for all IBD patients using 5-ASA: 37% (0.6%); biologicals: 31% (1.8%), p < 0.0001). Biologicals were more commonly prescribed in CD after 2010 (4% (0.2%) vs. 16% (0.6%), p < 0.0001), especially in patients less than 40 years old at diagnosis. Thiopurine exposure increased in IBD patients after 2010 (CD: 21% (0.4%) vs. 24% (0.6%) p < 0.0001; UC: 13% (0.4%) vs. 16% (0.7%), p < 0.0001), while methotrexate use remained overall low (overall 5 years probability in CD: 4% (0.1%) ;UC: 1% (0.1%); p < 0.0001). Corticosteroid exposure was unchanged before and after 2010 (CD: 31% (0.4%) vs. 30% (0.7%) p = 0.46; UC: 31% (0.5%) vs. 34% (0.9%); p = 0.03). 5-ASA use was higher in UC (40% (0.4%), p < 0.001), while in CD it became lower after 2010 (33% (0.4%) vs. 21% (0.6%), p < 0.0001). The probability of first hospitalisation remained unchanged whilst the probability of first major surgery was increased despite the higher and earlier use of biological therapies in this large population-based inception cohort from Québec. Overall, there was a slight increase in the use of thiopurines and methotrexate, while the use of corticosteroids was unchanged.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".