P1239Divided by distance: Insights into regional disparities in Inflammatory Bowel Disease care across Australia from the Crohn’s Colitis Care Registry

Abstract Background Australia’s vast geography presents ongoing challenges for equitable inflammatory bowel disease (IBD) care, where access to specialised services often requires significant travel. Evolving management strategies, including subcutaneous biologics and telehealth, offer potential to overcome such barriers, but their impact on equitable care access remains unclear. We assessed geographic and healthcare access disparities in IBD care across Australia using the Crohn’s Colitis Care (CCCare) registry. Methods Prospectively entered registry data were used. Individuals with Crohn’s disease (CD) and ulcerative colitis (UC) across Australian centres, with a clinical assessment within the last 14 months were included. Data were extracted in April 2025. Group comparisons were performed using descriptive statistics. Multivariable regression analyses were conducted adjusting for age, sex, ethnicity, and disease duration. Results Of 5,886 people with IBD included, 24% resided in non-metropolitan areas. These individuals had greater distance to IBD centres (median 97.1 vs 8.5 km, p 0.001), lower median socio-economic status (SEIFA 4 vs 7, p 0.001), lower tertiary education (45.3% vs 61.1%, p 0.001), and higher current smoking rates (14.8% vs 12.2%, p 0.01). Current advanced therapy use was lower among non-metropolitan individuals (44.5% vs 53.1%; p = 0.01), primarily due to differences observed in UC (p = 0.02). Immunomodulator use was higher in non-metropolitan groups (30.0% vs 25.9%; p 0.001), while combination therapy rates were comparable. Subcutaneous biologic use was also more frequent in this group (p 0.001), though 48% of CD and 79% of UC individuals still received intravenous therapy. Metropolitan individuals had higher rates of endoscopic and radiological remission (OR 1.69 and 1.52 respectively, both p 0.05). Non-metropolitan individuals had fewer annualised face-to-face reviews (IRR 0.62, 95% CI 0.56–0.68; p 0.00), without greater utilisation of telehealth (p = 0.72). Hospitalisation and surgery rates were comparable. Conclusion People with IBD in regional and remote Australia face ongoing disparities in care. Lower advanced therapy use despite lower remission rates suggest delayed or inadequate treatment escalation, driven by limited specialist access. These care discrepancies, require targeted system reforms to ensure equitable and effective IBD care nationally. Conflict of interest: Dr. Wu, Rodger: No conflict of interest Caquilpan, Victor: No conflict of interest Wilson, William: No conflict of interest Andrews, Jane Mary: Grant: The work I will present was funded via CCCure. CCCure’s funding sources include grants for research and payments for data reports from Pharma including AbbVie, J&J, Takeda, Celltrion, Falk, Ferring, BMS, Janssen, Pfizer, Sandoz Connor, Susan Jane: Grant: Research Support: Abbvie, Agency for Clinical Innovation, Amgen, BMS, Chiesi, Celltrion, DrFalk, Ferring, Janssen, Medical Research Future Fund, Pfizer, South Western Sydney Local Health District, Sydney Partnership for Health, Research and Enterprise, Takeda and The Leona M and Harry B Helmsley Charitable Trust Personal Fees: Ad Boards: Abbvie, Amgen, BMS, Celltrion, Eli Lilly, Ferring, GSK, Janssen, Organon, Pfizer, Takeda Speaker Fees: Abbvie, Cornerstones Health, Dr Falk, Ferring, Janssen, Pfizer, Sandoz, Sydney IBD School, Takeda Educational Support: DrFalk, Sandoz, Takeda