TRENDS IN INFLAMMATORY BOWEL DISEASE INCIDENCE AND PREVALENCE ACROSS EPIDEMIOLOGIC STAGES: A GLOBAL SYSTEMATIC REVIEW WITH META-ANALYSIS
Julia Gorospe, Joseph W. Windsor, Lindsay Hracs, Stephanie Coward, Michael Buie, Joshua Quan, Léa Caplan, Ante Markovinović, Michael Cummings, Quinn Goddard, Tyler Williamson, Yvonne Abbey, María T. Abreu, Raja Affendi Raja Ali, Murdani Abdullah, Mansour Altuwaijri, Vineet Ahuja, Domingo Balderramo, Rupa Banerjee, Eric I. Benchimol, Çharles N. Bernstein, Eduard Brunet, Johan Burisch, Vui Heng Chong, Iris Dotan, Usha Dutta, Sara El Ouali, Angela Forbes, Anders Forss, Richard B. Gearry, Viet Hang Dao, Juanda Leo Hartono, Ida Hilmi, Fabian Julian-Banos, Jamilya Kaibullayeva, Paul Kelly, Paulo Gustavo Kotze, Péter L. Lakatos, Charlie W. Lees, Julajak Limsrivilai, Edward V. Loftus, Jonas F. Ludvigsson, Joyce Wing Yan Mak, Ka Kei Ng, Ola Olén, Remo Panaccione, Mukesh S Paudel, Abel Botelho Quaresma, David T. Rubin, Marcellus Simadibrata, Yang Sun, Hidekazu Suzuki, Martín Toro, Dan Turner, Beatriz Iade Vergara, Shu‐Chen Wei, Jesús K. Yamamoto‐Furusho, Kuk-Kyun Yang, Siew C. Ng, Gilaad G. Kaplan
Abstract
Abstract BACKGROUND Rising incidence and prevalence of inflammatory bowel disease (IBD) observed historically in early-industrialized regions now also appear in newly-industrialized and emerging regions. The epidemiology of IBD has been proposed to progress across epidemiologic stages: 1. Emergence (low incidence and prevalence); 2. Acceleration in Incidence (rapid rising incidence); and 3. Compounding Prevalence (stabilizing incidence, rapid rising prevalence). AIM To gather real-world data on the incidence and prevalence of IBD and characterize global regions in each epidemiologic stage by meta-analyses. METHODS Two previous systematic reviews (database inception–2010; 2010–2016) were updated with a search of MEDLINE, Embase, PubMed, and Web of Science (2017–2023) to identify all population-based studies reporting the incidence or prevalence of Crohn’s disease (CD) or ulcerative colitis (UC). International partners provided a secondary review of the included studies from their local regions. Incidence and prevalence rates (per 100,000 population), stratified by epidemiologic stage, were meta-analyzed to determine pooled rates with associated 95% confidence intervals (95%CI). A Cochrane Q test was used to investigate differences between epidemiologic stages for both CD and UC. RESULTS After assessing 1,250 manuscripts, a total of 491 studies (439 incidence, 228 prevalence) from 80 global regions spanning 1920-2022 were identified by the systematic review (Figure 1). All data identified with our search strategy are available to view in an open-access, online interactive data repository (https://gives21.shinyapps.io/dashboard/) created with Shiny for R. The pooled incidence of CD and UC per 100,000 person-years rose from 0.28 (95%CI: 0.21, 0.36) and 0.57 (95%CI: 0.47, 0.69) in Stage 1 to 2.13 (95%CI: 1.88, 2.42) and 4.05 (95%CI: 3.65, 4.50) in Stage 2 to 9.34 (95%CI: 8.73, 9.99) and 14.07 (95%CI: 13.09, 15.12) in Stage 3 (Table 1). Similarly, the pooled prevalence of CD and UC per 100,000 persons rose from 1.96 (95%CI: 1.41, 2.74) and 6.35 (95%CI: 4.45, 9.07) in Stage 1 to 22.18 (95%CI: 17.96, 27.38) and 45.36 (95%CI: 37.84, 54.38) in Stage 2 to 186.18 (95%CI: 163.18, 212.42) and 255.92 (95%CI: 230.60, 284.02) in Stage 3 (Table 1). Subgroup analysis confirmed differences in both incidence and prevalence for CD and UC between epidemiologic stages (p<0.001). DISCUSSION This is the most comprehensive systematic review on the incidence and prevalence of IBD. The amalgamated real-world data from this study highlight the rising global burden of IBD across three distinct epidemiologic stages: 1. Emergence, 2. Acceleration in Incidence, and 3. Compounding Prevalence. Figure 1 Systematic review study selection flowchart including a brief overview of two previous systematic reviews: Molodecky, N.A. et al. Gastroenterology. 2012;142(1):46-54 and Ng, S.C. et al. Lancet. 2017;390(10114):2769-78. Table 1 Pooled incidence and prevalence rates per 100,000 population for Crohn’s disease and ulcerative colitis. Cochrane Q subgroup analysis for difference in estimates between epidemiologic stages. † Represents the number of study-subregion groups used in the calculation of pooled rates and their 95% confidence intervals.