The Time to Inflammatory Bowel Disease Diagnosis for Patients Presenting with Abdominal Symptoms in Primary Care and its Association with Emergency Hospital Admissions and Surgery: A Retrospective Cohort Study.

IF 4.5 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Inflammatory Bowel Diseases Pub Date : 2025-01-06 DOI:10.1093/ibd/izae057

Nosheen Umar, Phil Harvey, Nicola J Adderley, Shamil Haroon, Nigel Trudgill

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Abstract

Background: Patients with inflammatory bowel disease (IBD) presenting to primary care may experience diagnostic delays. We aimed to evaluate this and assess whether time to diagnosis is associated with clinical outcomes.

Methods: A retrospective cohort study using English primary care data from January 1, 2010, to December 31, 2019, linked to hospital admission data was undertaken. Patients were followed from the first IBD-related presentation in primary care to IBD diagnosis. Associations of time to diagnosis exceeding a year were assessed using a Robust Poisson regression model. Associations between time to diagnosis and IBD-related emergency hospital admissions and surgery were assessed using Poisson and Cox proportional hazards models, respectively.

Results: Of 28 092 IBD patients, 60% had ulcerative colitis (UC) and 40% had Crohn's disease (CD). The median age was 43 (interquartile range, 30-58) years and 51.9% were female. Median time to diagnosis was 15.6 (interquartile range, 4.3-28.1) months. Factors associated with more than a year to diagnosis included female sex (adjusted risk ratio [aRR], 1.23; 95% CI, 1.21-1.26), older age (aRR, 1.05; 95% CI, 1.01-1.10; comparing >70 years of age with 18-30 years of age), obesity (aRR, 1.03; 95% CI, 1.00-1.06), smoking (aRR, 1.05; 95% CI, 1.02-1.08), CD compared with UC (aRR, 1.13; 95% CI, 1.11-1.16), and a fecal calprotectin over 500 μg/g (aRR, 0.89; 95% CI, 0.82-0.95). The highest quartile of time to diagnosis compared with the lowest was associated with IBD-related emergency admissions (incidence rate ratio, 1.06; 95% CI, 1.01-1.11).

Conclusion: Longer times to IBD diagnoses were associated with being female, advanced age, obesity, smoking, and Crohn's disease. More IBD-related emergency admissions were observed in patients with a prolonged time to diagnosis.

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基层医疗机构对腹部症状患者进行炎症性肠病诊断的时间及其与急诊入院和手术的关系：一项回顾性队列研究

背景：到基层医疗机构就诊的炎症性肠病（IBD）患者可能会被延误诊断。我们旨在对此进行评估，并评估诊断时间是否与临床结果相关：我们使用 2010 年 1 月 1 日至 2019 年 12 月 31 日的英国初级医疗数据，并将其与入院数据相链接，开展了一项回顾性队列研究。研究人员对患者从首次在初级医疗机构出现 IBD 相关症状到确诊 IBD 的整个过程进行了跟踪。使用稳健泊松回归模型评估了确诊时间超过一年的相关性。诊断时间与 IBD 相关急诊入院和手术之间的关系分别使用泊松模型和 Cox 比例危险模型进行评估：在 28 092 名 IBD 患者中，60% 患有溃疡性结肠炎（UC），40% 患有克罗恩病（CD）。中位年龄为 43 岁（四分位间范围为 30-58 岁），51.9% 为女性。确诊时间中位数为 15.6 个月（四分位间范围为 4.3-28.1 个月）。与确诊时间超过一年相关的因素包括女性（调整风险比 [aRR]，1.23；95% CI，1.21-1.26）、年龄较大（aRR，1.05；95% CI，1.01-1.10；将年龄大于 70 岁与 18-30 岁进行比较）、肥胖（aRR，1.03；95% CI，1.00-1.06）、吸烟（aRR，1.05；95% CI，1.02-1.08）、CD 与 UC 相比（aRR，1.13；95% CI，1.11-1.16）、粪便钙蛋白超过 500 μg/g（aRR，0.89；95% CI，0.82-0.95）。诊断时间的最高四分位数与最低四分位数相比，与IBD相关的急诊入院率相关（发病率比，1.06；95% CI，1.01-1.11）：结论：女性、高龄、肥胖、吸烟和克罗恩病与较长的 IBD 诊断时间有关。在确诊时间较长的患者中，与 IBD 相关的急诊入院人数较多。

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来源期刊

Inflammatory Bowel Diseases 医学-胃肠肝病学

CiteScore

9.70

自引率

6.10%

发文量

462

审稿时长

1 months

期刊介绍： Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.