Adolescents with inflammatory bowel disease (IBD) experienced significantly lower steroid and biological use and fewer hospitalizations when treated in a pediatric care setting, according to study results published in the Journal of Pediatric Gastroenterology and Nutrition.
Adolescent IBD differs from adult disease in disease extent and long-term treatment outcomes. The investigators of this Dutch population-based cohort study sought to assess how pediatric vs adult-oriented care settings affected health outcomes in adolescent patients with IBD.
The study included 626 adolescents, aged 16 to 18 years, with IBD. Participants were categorized according to pediatric (n=380) or adult-oriented (n=246) care setting and were followed until age 19 or until the participants were transferred into adult care. Primary outcomes of interest were IBD-related hospital admissions and IBD-related surgery (identified using a Dutch insurance claims database) and corticosteroid or biological use (identified using IBD-related pharmaceutical prescription codes). Utilization rates were estimated using Cox proportional hazards and adjusted for potential confounders, including age, gender, hospital type, disease stage, and disease phenotype.
Participants who were treated in a pediatric care setting were significantly less likely to be treated with corticosteroids (hazard ratio [HR] 0.72; 95% CI, 0.52-0.99) and were prescribed biologicals at nearly half the adult care setting rate (HR 0.57, 95% CI, 0.34-0.97). Furthermore, patients in a pediatric care setting had significantly fewer IBD-related hospital admissions (HR 0.58, 95% CI, 0.37-0.92). These patients also had lower rates of IBD-related surgery, but the difference did not reach clinical significance (HR 0.51; 95% CI, 0.18-1.39).
Limitations to the study included incomplete data on disease phenotype in the pediatric group and unobserved factors, like disease activity or severity were not controlled for; however, the investigators suggest that patients with severe IBD would be more likely to use steroids and biologicals and more frequently be hospitalized. Data used in the study were collected for administrative purposes and were therefore limited in detail regarding secondary diagnoses and laboratory results.
The researchers of the study concluded that although a significant proportion of adolescents with IBD are treated in an adult-oriented setting, improved clinical care outcomes (significantly lower steroid and biological use without increased hospital admissions) for this patient population are associated with a pediatric care setting.
Bottema RWB, de Vries H, Houwen RHJ, van Rheenen PF. Impact of pediatric versus adult care setting on health care utilization in adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2019;69(3):310-316.