Estimates of Disease Course in Inflammatory Bowel Disease Using Administrative Data: A Population-level Study

Abstract

Background and aims: We sought develop a predictive model of disease course in inflammatory bowel disease [IBD] using health care utilization measures from administrative health data, and to apply this model to estimate disease course at a population level over time.

Methods: Study participants were IBD patients who were prospectively followed for a 1-year period between 2009 and 2010 in a Canadian clinic setting to assess their IBD disease course [i.e. remission, mild, moderate, severe]. Clinic data were linked with population-based administrative health data. A multivariable partial proportional odds model tested health care utilization measures that discriminated disease course groups. The model was applied to project the distribution of disease course for the Manitoba IBD population for 1995-2013.

Results: There were 407 participants (54.3% females, 64.4% Crohn's disease [CD]) with mean age at diagnosis of 29.8 years [SD 14.9]. Forty-one per cent of participants were clinically in remission, while 14.0% had severe IBD. Mild, moderate or severe disease was associated with three or more gastroenterologist visits (odds ratio [OR] = 3.33, 95% confidence interval [CI]: 2.03-5.54) or three or more general practitioner visits [OR = 2.97, 95% CI: 1.44-6.37] with an IBD diagnosis and ≥1 radiology test [OR = 2.22, 95% CI: 1.31-3.80]. The percentages of the Manitoba IBD population in remission rose steadily from 1995 to 2013 [43.6 to 59.9%], while the percentages of individuals with mild, moderate or severe disease declined.

Conclusion: This study demonstrated that health care utilization measures from administrative data can be used to predict disease course in the IBD population.

Keywords: Crohn’s disease; disease course; predictive model; ulcerative colitis.