Abstract

BACKGROUND: Timely diagnosis and treatment of inflammatory bowel disease (IBD) may improve clinical outcomes. OBJECTIVE: Examine associations between time to diagnosis, patterns of prior healthcare use and, clinical outcomes in IBD. DESIGN: Using the Clinical Practice Research Datalink we identified incident cases of Crohn’s disease (CD) and ulcerative colitis (UC), diagnosed between 01/2003 - 05/2016, with a first primary care gastrointestinal consultation during the 3-year period prior to IBD diagnosis. We used multivariable Cox regression to examine the association of primary care consultation frequency (n=1, 2, >2), annual consultation intensity, hospitalisations for gastrointestinal symptoms, and time to diagnosis with a range of key clinical outcomes following diagnosis. RESULTS: We identified 2,645 incident IBD cases (CD:782; UC:1,863). For CD, >2 consultations were associated with intestinal surgery (adjusted Hazard Ratio (aHR)=2.22, CI:1.45-3.39) and subsequent CD-related hospitalisation (aHR=1.80, CI:1.29-2.50). For UC, >2 consultations was associated with corticosteroid dependency (aHR=1.76, CI:1.28-2.41), immunomodulator use (aHR=1.68, CI:1.24-2.26), UC-related hospitalisation (aHR=1.43, CI:1.05-1.95) and colectomy (aHR=2.01, CI:1.22-3.27). For CD, hospitalisation prior to diagnosis was associated with CD-related hospitalisation (aHR=1.30, CI:1.01-1.68) and intestinal surgery (aHR=1.71, CI:1.13-2.58); for UC, it was associated with immunomodulator use (aHR=1.42, CI:1.11-1.81), UC-related hospitalisation (aHR=1.36, CI:1.06-1.95) and colectomy (aHR=1.54, CI:1.01-2.34). For CD, consultation intensity in the year before diagnosis was associated with CD-related hospitalisation (aHR=1.19, CI:1.12-1.28) and intestinal surgery (aHR=1.13, CI:1.03-1.23); for UC, it was associated with corticosteroid use (aHR=1.08, CI:1.04-1.13), corticosteroid dependency (aHR=1.05, CI:1.00-1.11), and UC-related hospitalisation (aHR=1.12, CI:1.03-1.21). For CD, time to diagnosis was associated with risk of CD-related hospitalisation (aHR=1.03, CI:1.01-1.68); for UC, it was associated with reduced risk of UC-related hospitalisation (aHR=0.83, CI:0.70-0.98) and colectomy (aHR=0.59, CI:0.43-0.80). CONCLUSION: Electronic records contain valuable information about patterns of healthcare use that can be used to expedite timely diagnosis and identify aggressive forms of IBD.