Background Marked variation in access to care and health services utilization is a marker of variation in quality of care. With the rising incidence of pediatric inflammatory bowel disease (IBD), we must understand variation in access to and outcomes of care to improve quality. Purpose Describe variation in care for pediatric IBD treated in 4 Canadian provinces. Method Incident cases of IBD diagnosed in children <16y were identified from health administrative data in Alberta (AB), Manitoba, Nova Scotia, and Ontario (ON) using validated algorithms. Children were assigned to one of 8 centres of care using a hierarchical assessment of health services use within 6 months of diagnosis. Children treated by adult gastroenterologists or community-based pediatric gastroenterologists were excluded due to small sample size. Outcomes included IBD-related hospitalizations, emergency department (ED) visits (AB/ON only), and IBD-related abdominal surgery. Hospitalizations and ED visits were counted cumulatively from 6-60 months after diagnosis. The risk of first surgery was defined during the same 6-60 month period. Mixed-effects meta-analysis was used to pool results across centres. Heterogeneity among centres was quantified using I2 (variation in pooled event rates between centres) and τ (standard deviation of the true event rates). R2 quantified the residual heterogeneity in outcomes not attributable to among-province variation. Result(s) We identified 3777 incident cases of pediatric IBD, 2936 (78%) of which were treated at 8 pediatric centres. The number of hospitalizations was 0.67 (95% CI 0.56-0.79) per person with high between-centre heterogeneity (I2 84%, τ 0.1556). Provincial differences accounted for 93% of heterogeneity across centres (residual heterogeneity: I2 29%, τ 0.0412). Hospitalizations were less frequent in AB than other provinces (0.43 vs. 0.72-0.78). Children averaged 1.94 IBD-related ED visits, with significant heterogeneity (I2 99%, τ 1.33) with 99.7% of heterogeneity attributable to among-province differences (residual heterogeneity: I2 32%; τ 0.074). Mean ED visits were 1.1 visits in ON (I2 39%) and 3.7 in AB (I2 0%). Intestinal resection was required by 12% (95% CI 0.08-0.15) of Crohn’s patients with high among-centre heterogeneity (I2 81%, τ 0.042), and low (19%) heterogeneity due to provincial differences (residual heterogeneity: I2 76%; τ 0.039). Colectomy was required by 12% (95% CI 10-14) of children with ulcerative colitis (UC) with no between-centre heterogeneity (I2 0%, τ 0). Conclusion(s) There is a high degree of between-province (but not between-centre, within province) variability in health services utilization among children with IBD. There was significant between-centre variability in surgery rates for Crohn’s, but not colectomy for UC. Differences in patient characteristics or provincial health systems may be more important predictors of variation in care. Surgery for Crohn’s disease may be a target for inter-centre quality improvement efforts. Please acknowledge all funding agencies by checking the applicable boxes below CCC Disclosure of Interest None Declared

Background The relapsing and remitting symptoms experienced by people with inflammatory bowel disease (IBD), including abdominal pain and diarrhea, may impact their employability and workplace productivity. Purpose Report the impact of IBD on missed work and its associated costs using population-representative data with the goal of understanding the population-level indirect costs of IBD in Canada. Method We used the 2010 and 2014 waves of the Canadian Community Health Survey (CCHS) to compare missed work and its associated costs among survey respondents aged 20 to 64 years with physician-diagnosed IBD compared to those without IBD. Students and those with non-IBD bowel disorders were excluded. The cost of missed work was derived from reported annual income and the number of workdays missed. Survey weights were used for descriptive statistics. Poisson regression modified for binary outcomes was used to compare employment within the past 3 months among those with and without IBD. Heckman models (two-stage models accounting for the likelihood of being employed) were used to compare the number of days missed and the cost of missed work in the two groups. Models were adjusted for age, sex, education, marital status, immigration status, visible minority status, number of non-IBD chronic conditions, and mood or anxiety disorder. All costs were inflation-adjusted to 2022 Canadian dollars. Result(s) Among 67,907 eligible respondents, 810 (weighted 1.0%) had IBD. Employment in the last 3 months was reported among 70% of people with IBD compared to 80% of people without IBD (RR 0.92, 95% CI 0.88 to 0.96). Among those employed in the prior 3 months, employed people with IBD missed an average of 1.6 (SD 4.4) days of work compared to 1.0 (SD 3.5) days missed among those without IBD, corresponding to $415 (SD 1315) in lost wages among those with IBD and $235 (SD 932) among those without IBD. Accounting for the higher rates of unemployment in those with IBD using Heckman models, people with IBD missed an additional 1.1 days (95% CI 0.7 to 1.5) of work and lost an additional $270 (95% CI 163 to 377) in income over 3 months. Extrapolating to the estimated 184,460 employed Canadians with IBD, the attributable indirect cost of missed work due to IBD is nearly $200 million annually. Conclusion(s) The economic burden of IBD resulting from missed work is substantial. Since IBD is often diagnosed during adolescence and early adulthood, employability and productivity are important long-term patient-centered outcomes. Novel interventions that could mitigate these attendant effects of IBD are urgently needed to improve patient outcomes. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Background Inflammatory bowel disease (IBD) is a chronic disorder that can be managed but not cured. The relapsing and remitting symptoms of IBD impact patients' quality of life and is associated with considerable healthcare costs. Different mobile health apps have been developed around the world for IBD and other chronic medical conditions. These apps can potentially decrease healthcare utilization and the burden of the disease. Purpose We aimed to review IBD mobile health apps available in English and evaluate their quality and content. Method We searched the Apple Store and Play Store in July 2022 using IBD-related keywords (e.g., “IBD,” “Crohn,” “Crohns,” “colitis,” “ulcerative colitis,” and “inflammatory bowel disease.”) to identify apps for iOS and Android devices, respectively. We included apps available in English, designed specifically for IBD, and free to download and use. Two researchers reviewed, rated, and evaluated the retrieved apps independently. The Mobile App Rating Scale (MARS) was used to rate the included apps. The MARS rates apps on a scale of 1 to 5 and includes an overall score as well as scores for engagement, functionality, information, aesthetics, and subject quality. A score ≥3 is deemed acceptable. Result(s) Search queries yielded 88 relevant apps, of which 38 met the inclusion criteria and were included in this review. The included apps for IBD were most tracking and monitoring symptoms of the disease (n=22). Two of the apps were affiliated with universities, and three of the apps were specifically developed for children. In addition, 11 apps were designed for IBD, regardless of disease subtype (Crohn’s disease [CD] or ulcerative colitis [UC]), and 27 apps were designed specifically for either UC or CD. The mean MARS score for IBD apps was 3.3 (SD=0.6), with more than half deemed acceptable. Apps scored highest on the functionality (mean=3.7, SD=0.6) and information (mean=3.6, SD=0.5) dimension of MARS and lowest on the engagement dimension (mean=3, SD=0.8). Image Conclusion(s) Most IBD-related apps provide acceptable information and functionality but should improve their engagement to be welcomed by users. This review provides a roadmap for improving available apps and future app development for individuals with IBD. App developers in the field of IBD must ensure they create high-quality, engaging, esthetic and evidence-based apps. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Background In Canada, the incidence of inflammatory bowel disease (IBD) is increasing faster among those <10 years (y) of age than in any other age group. Understanding the health services burden of IBD in this population is important for health system planning. Purpose To compare healthcare utilization and risk of surgery among children diagnosed with IBD across age groups defined by the Paris Classification (A1a: <10y; A1b: 10 to <16y) across 5 Canadian provinces. Method Children diagnosed with IBD <16 years of age were identified from health administrative data using validated algorithms in Alberta, Manitoba, Nova Scotia, Ontario, and Québec. Negative binomial regression models were used to compare (1) the pre-diagnosis frequency of health services utilization (outpatient, emergency department (ED), and hospitalization) using diagnostic codes suggestive of future IBD and (2) the annual post-diagnosis frequency of IBD-specific and IBD-related (signs, symptoms, and extra-intestinal manifestations of IBD) visits among children diagnosed <10y (A1a) and 10 to <16y (A1b). Cox proportional hazard models compared the risk of surgery (identified with validated procedure codes) across age groups. All regression models were adjusted for sex, rural/urban residence, and mean neighbourhood income quintile. Province-specific event counts (all ages combined) and models (comparing age groups; reference: A1b [10 to <16y]) were pooled using random-effects meta-analysis. Result(s) Among 5124 children with IBD (1165 [23%] were <10y at diagnosis), the mean number of pre-diagnosis healthcare encounters was 1.0 (95% CI 0.38 to 1.68, I2=99.6%). The mean annual post-diagnosis number of IBD-specific outpatient visits was 3.2 (95% CI 1.9-4.4, I2=99.6%); hospitalizations, 0.19 (95% CI 0.17-0.21, I2=74%); ED visits, 0.17 (95% CI 0.19-0.39, I2=99%). The mean annual post-diagnosis number of IBD-related outpatient visits was 3.9 (95% CI 2.3-5.5, I2=99.7%); hospitalizations, 0.21 (95% CI 0.19-0.23, I2=79%); ED visits, 0.29 (95% CI 0.19-0.39, I2=97%). Intestinal resection or colectomy within 5y of diagnosis occurred in 13% (95%CI 8-22, I2=93%) with Crohn’s disease (CD) and 16% (95% CI 14-18, I2=40%) with ulcerative colitis. IBD-specific ED visits (RR 0.70, 95% CI 0.50-0.97, I2=80) and the risk of intestinal resection in CD (HR 0.49, 95% CI 0.26-0.92, I2=40%) were significantly lower among children diagnosed <10y. There were no age-related differences in pre-diagnosis health services utilization or other post-diagnosis outcomes, including frequency of outpatient visits to a gastroenterologist. Conclusion(s) Health services utilization was generally similar for children diagnosed with IBD at <10y and between 10 and <16y, except for lower rates of IBD-specific ED visits and intestinal resection in children with CD. Further exploration of between-province differences, represented by the high statistical heterogeneity (I2) in the meta-analyses, is needed to understand sources of variation in care. Please acknowledge all funding agencies by checking the applicable boxes below CCC Disclosure of Interest E. Kuenzig: None Declared, H. Singh Consultant of: Amgen Canada, Bristol-Myers Squibb Canada, Sandoz Canada, Roche Canada, Takeda Canada and Guardant Health, A. Bitton: None Declared, G. Kaplan Grant / Research support from: Ferring, Consultant of: AbbVie, Janssen, Pfizer, Amgen, Sandoz, Pendophram, and Takeda, Speakers bureau of: AbbVie, Janssen, Pfizer, Amgen, Sandoz, Pendophram, and Takeda, M. Carroll: None Declared, A. Otley Grant / Research support from: Research support: AbbVie Global. Research site: AbbVie, Pfizer, Eli-Lily, Janssen, Consultant of: AbbVie Canada, T. Stukel: None Declared, S. Spruin: None Declared, A. Griffiths Grant / Research support from: Abbvie, Consultant of: Abbvie, Amgen, BristolMyersSquibb, Janssen, Lilly, Takeda, Speakers bureau of: Abbvie, Janssen, Takeda, D. Mack: None Declared, K. Jacobson Grant / Research support from: Abbvie Canada and Janssen Canada, Consultant of: Abbvie Canada, Janssen Canada, Merck Canada and Mylan Pharmaceuticals, Speakers bureau of: Abbvie Canada and Janssen Canada, G. Nguyen: None Declared, L. Targownik Grant / Research support from: Janssen Canada, Consultant of: AbbVie Canada, Sandoz Canada, Takeda Canada, Merck Canada, Pfizer Canada, Janssen Canada, and Roche Canada, W. El-Matary Consultant of: Abbvie and MERCK, Speakers bureau of: Abbvie and MERCK, E. Benchimol Consultant of: McKesson Canada, Dairy Farmers of Ontario (unrelated to medications used to treat inflammatory bowel disease)

Background Inflammatory bowel disease (IBD) is a chronic inflammatory disease primarily affecting the gastrointestinal tract. Despite treatment with the current standards of care, many IBD patients experience relapsing, remitting, and disabling bowel symptoms and significant disease complications. Ensuring patients have adequate access to high quality multidisciplinary healthcare is vital for the short- and long-term wellbeing of IBD patients. Purpose (1) Compare unmet healthcare needs of people with and without IBD. (2) Determine whether accessing regular medical care mediates the association between IBD and unmet healthcare needs. (3) Describe the reasons for unmet healthcare needs among people with and without IBD. Method We used the 2014 Canadian Community Health Survey, a population-representative national cross-sectional survey conducted by Statistics Canada. Respondents with a non-IBD bowel disorder or aged 18 or younger were excluded. Survey weights were used for descriptive statistics. We used multilevel logistic regression to compare perceived unmet healthcare needs among individuals with and without IBD, clustering by health region and controlling for age, immigration status, race, home ownership, marital status, annual household income, education level, and number of chronic conditions (0, 1, 2+). In a second model, we additionally controlled for having a regular family doctor, having consulted a specialist, and having consulted a psychologist to assess if regularly accessing medical care mediated the association between IBD and unmet healthcare needs. Individuals reporting unmet healthcare needs were asked about the reasons for their unmet healthcare needs. Responses are summarized with weighted percentages, plotted in a bar graph. Result(s) Among the 690 IBD and 62,832 non-IBD eligible survey respondents, 16.7% of people with IBD had an unmet healthcare need within the past 12 months, compared with 10.3% of those without IBD (OR 1.39, 95% CI 1.12 to 1.74). Additionally adjusting for regular access to medical care slightly attenuated the association between IBD and unmet healthcare needs (OR 1.29, 95% CI 1.03 to 1.62). Reasons for unmet healthcare needs differed among those with and without IBD (Figure). Specifically, doctors believing that care was unnecessary and the cost of care were more likely to be the reason people with IBD had an unmet healthcare need. Image Conclusion(s) People with IBD are more likely to have an unmet healthcare need that was partially mediated by access to healthcare professionals. Our work highlights the need for further research into the types of unmet healthcare needs experienced by people living with IBD. This underscores the need for multidisciplinary healthcare teams to address the increased burden of unmet healthcare needs in the IBD population. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest G. Postill: None Declared, E. Benchimol Consultant of: Hoffman La-Roche Limited and Peabody & Arnold LLP for matters unrelated to medications used to treat inflammatory bowel disease. Dr. Benchimol has also acted as a consultant for McKesson Canada and the Dairy Farmers of Ontario for matters unrelated to medications used to treat inflammatory bowel disease., J. Im: None Declared, A. Tang: None Declared, E. Kuenzig: None Declared