HEALTH CARE UTILIZATION DIFFERENCES BETWEEN FIRST NATIONS AND THE GENERAL POPULATION WITH INFLAMMATORY BOWEL DISEASE IN SASKATCHEWAN

• Main Author: Marques Santos, Jose Diego
• Other Authors: Peña-Sánchez, Juan-Nicolás, Jennings, Derek, Brass, Colten, Fowler, Sharyle, Oosman, Sarah, Muhajarine, Nazeem
• Format: Thesis
• Language: unknown
• Published: University of Saskatchewan 2021
• Subjects: inflammatory bowel disease; First Nations; health care; Saskatchewan
• Online Access: https://hdl.handle.net/10388/13335

Background: Indigenous patients with inflammatory bowel disease (IBD) have expressed concerns about barriers to access IBD care. The limited evidence of IBD among Indigenous people highlights the need for studies evaluating access to IBD care in this population. Aim: This study aimed to compare health care utilization between First Nations and the general population diagnosed with IBD in Saskatchewan. Methods: A population-based retrospective cohort study was conducted using administrative health databases of Saskatchewan from 1998 to 2017 fiscal years. As a patient-oriented research initiative, outcomes of interest were chosen in collaboration with Indigenous patients and family advocates (Indigenous individuals living with IBD and family members of an Indigenous person with the disease). A validated algorithm requiring multiple health care contacts was applied to identify incident IBD cases. The self-declared First Nations status variable was used to divide IBD cases between First Nations and the general population. A 1:5 age and sex matching was applied. Cox-proportional models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CI). Results: A matched cohort with 696 IBD incident cases was created (First Nations=116, general population=580). Comparing health care utilization of First Nations and individuals from the general population with IBD, there were no statistically significant differences in outpatient gastroenterology visits (First Nations=81.0%, general population=83.6%; HR=1.13, 95% CI: 0.90-1.41), colonoscopies (First Nations=91.4%, general population=86.9%; HR=1.14, 95% CI: 0.92-1.41), and surgeries for IBD (First Nations =31.0%, general population=33.5%; HR=1.14, 95% CI: 0.80-1.64). In contrast, adjusting by rural or urban residence at the date of diagnosis and diagnostic type, differences between the groups were observed for any IBD medication claim (First Nations=79.3%, general population=89.3%; HR=0.52, 95% CI: 0.41-0.65), 5-ASA claims (First Nations=75.9%, general population=81.4%; HR=0.56, 95% CI: 0.45-0.71), and IBD-specific (First Nations=54.3%, general population=49.3%; HR=1.33, 95% CI: 1.01-1.75) and IBD-related hospitalizations (First Nations=63.8%, general population=52.8%; HR=1.55, 95% CI: 1.20-2.01). Conclusions: This study identified that First Nations had a higher risk of having an IBD-specific and IBD-related hospitalization compared to individuals IBD from the general population. Additionally, it was found an inverse association between First Nations status and having prescription medication claims for IBD in Saskatchewan. These associations could reflect a barrier to access IBD medications, contributing to a higher risk for IBD-specific or -related hospitalizations in the First Nations group. Multiple confounding variables were considered when evaluating these associations, but it was not possible to control by disease severity. Further studies should continue evaluating access to IBD care, medication use, hospitalization rates, and disease severity among First Nations living with IBD.