JF McLaughin et al. Clin Gastroenterol Hepatol 2025; 23: 825-834. Travel Time to Treating Center Is Associated With Diagnostic Delay in Pediatric Inflammatory Bowel Disease

This was a cross-sectional study of newly diagnosed pediatric patients (n=869) with IBD at 22 United States sites from 2019 to 2022. 57% were diagnosed with CD, 34% with UC, and 4% with IBD-U.

Key findings:

• Overall, the mean time from symptom onset to diagnosis was 265.9 days
• Factors associated with longer diagnosis time included CD vs UC (odds ratio [OR], 2.6), and longer travel time to clinic (>1 hour [OR, 1.7], >2 hours [OR, 1.8] each vs <30 minutes)
• There was no association with race, ethnicity, birth country, gender, parent education, household income, insurance type, health literacy, and health system distrust

The finding that there is a longer diagnostic delay with CD than UC is consistent with prior studies. The longer travel time has not been widely recognized as a factor associated with delayed diagnosis, though it has been associated with other negative outcomes like higher mortality with chronic liver disease.

Regarding the lack of a negative impact from factors like race/ethnicity and income, my suspicion is that this is probably related to several factors:

• Overall, the pediatric age group has a very high rate of being insured as most children without commercial insurance currently qualify for Medicaid. This helps improve access to needed/timely health care
• A recent study showed that pediatric GI specialists do not have disparities in treatment compared to pediatric GI providers with an IBD focus; thus, pediatric specialists are more likely to minimize treatment delay (Treatment Disparities in Adult vs. Pediatric IBD Care Related to Provider Specialization)
• Parents help limit diagnostic delay in their children

My take: There are many places that are far away from pediatric specialists. This results in diagnostic delays.

Related blog posts:

• Distance from Transplant Center -Not a Good Thing for Chronic Liver Disease DS Goldberg et al. Clin Gastroenterol Hepatol 2017; 15: 958-60 showed that increased distance to a liver transplant center was associated with higher mortality for patients with chronic liver failure (CLF).
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• How Often is Arthritis a Presenting Feature of Pediatric IBD & How to Make the Right Diagnosis
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• Delays in diagnosing Crohn’s disease
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