The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
GBD 2017 Inflammatory Bowel Disease Collaborators, Sudabeh Alatab, Sadaf G Sepanlou, Kevin Ikuta, Homayoon Vahedi, Catherine Bisignano, Saeid Safiri, Anahita Sadeghi, Molly R Nixon, Amir Abdoli, Hassan Abolhassani, Vahid Alipour, Majid A H Almadi, Amir Almasi-Hashiani, Amir Anushiravani, Jalal Arabloo, Suleman Atique, Ashish Awasthi, Alaa Badawi, Atif A A Baig, Neeraj Bhala, Ali Bijani, Antonio Biondi, Antonio M Borzì, Kristin E Burke, Félix Carvalho, Ahmad Daryani, Manisha Dubey, Aziz Eftekhari, Eduarda Fernandes, João C Fernandes, Florian Fischer, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Amir Hasanzadeh, Maryam Hashemian, Simon I Hay, Chi L Hoang, Mowafa Househ, Olayinka S Ilesanmi, Nader Jafari Balalami, Spencer L James, Andre P Kengne, Masoud M Malekzadeh, Shahin Merat, Tuomo J Meretoja, Tomislav Mestrovic, Erkin M Mirrakhimov, Hamid Mirzaei, Karzan A Mohammad, Ali H Mokdad, Lorenzo Monasta, Ionut Negoi, Trang H Nguyen, Cuong T Nguyen, Akram Pourshams, Hossein Poustchi, Mohammad Rabiee, Navid Rabiee, Kiana Ramezanzadeh, David L Rawaf, Salman Rawaf, Nima Rezaei, Stephen R Robinson, Luca Ronfani, Sonia Saxena, Masood Sepehrimanesh, Masood A Shaikh, Zeinab Sharafi, Mehdi Sharif, Soraya Siabani, Ali Reza Sima, Jasvinder A Singh, Amin Soheili, Rasoul Sotoudehmanesh, Hafiz Ansar Rasul Suleria, Berhe E Tesfay, Bach Tran, Derrick Tsoi, Marco Vacante, Adam B Wondmieneh, Afshin Zarghi, Zhi-Jiang Zhang, Mae Dirac, Reza Malekzadeh, Mohsen Naghavi, GBD 2017 Inflammatory Bowel Disease Collaborators, Sudabeh Alatab, Sadaf G Sepanlou, Kevin Ikuta, Homayoon Vahedi, Catherine Bisignano, Saeid Safiri, Anahita Sadeghi, Molly R Nixon, Amir Abdoli, Hassan Abolhassani, Vahid Alipour, Majid A H Almadi, Amir Almasi-Hashiani, Amir Anushiravani, Jalal Arabloo, Suleman Atique, Ashish Awasthi, Alaa Badawi, Atif A A Baig, Neeraj Bhala, Ali Bijani, Antonio Biondi, Antonio M Borzì, Kristin E Burke, Félix Carvalho, Ahmad Daryani, Manisha Dubey, Aziz Eftekhari, Eduarda Fernandes, João C Fernandes, Florian Fischer, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Amir Hasanzadeh, Maryam Hashemian, Simon I Hay, Chi L Hoang, Mowafa Househ, Olayinka S Ilesanmi, Nader Jafari Balalami, Spencer L James, Andre P Kengne, Masoud M Malekzadeh, Shahin Merat, Tuomo J Meretoja, Tomislav Mestrovic, Erkin M Mirrakhimov, Hamid Mirzaei, Karzan A Mohammad, Ali H Mokdad, Lorenzo Monasta, Ionut Negoi, Trang H Nguyen, Cuong T Nguyen, Akram Pourshams, Hossein Poustchi, Mohammad Rabiee, Navid Rabiee, Kiana Ramezanzadeh, David L Rawaf, Salman Rawaf, Nima Rezaei, Stephen R Robinson, Luca Ronfani, Sonia Saxena, Masood Sepehrimanesh, Masood A Shaikh, Zeinab Sharafi, Mehdi Sharif, Soraya Siabani, Ali Reza Sima, Jasvinder A Singh, Amin Soheili, Rasoul Sotoudehmanesh, Hafiz Ansar Rasul Suleria, Berhe E Tesfay, Bach Tran, Derrick Tsoi, Marco Vacante, Adam B Wondmieneh, Afshin Zarghi, Zhi-Jiang Zhang, Mae Dirac, Reza Malekzadeh, Mohsen Naghavi
Abstract
Background: The burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017.
Methods: We modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95% uncertainty intervals (UI).
Findings: In 2017, there were 6·8 million (95% UI 6·4-7·3) cases of IBD globally. The age-standardised prevalence rate increased from 79·5 (75·9-83·5) per 100 000 population in 1990 to 84·3 (79·2-89·9) per 100 000 population in 2017. The age-standardised death rate decreased from 0·61 (0·55-0·69) per 100 000 population in 1990 to 0·51 (0·42-0·54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422·0 [398·7-446·1] per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6·7 [6·3-7·2] per 100 000 population). High Socio-demographic Index (SDI) locations had the highest age-standardised prevalence rate, while low SDI regions had the lowest age-standardised prevalence rate. At the national level, the USA had the highest age-standardised prevalence rate (464·5 [438·6-490·9] per 100 000 population), followed by the UK (449·6 [420·6-481·6] per 100 000). Vanuatu had the highest age-standardised death rate in 2017 (1·8 [0·8-3·2] per 100 000 population) and Singapore had the lowest (0·08 [0·06-0·14] per 100 000 population). The total YLDs attributed to IBD almost doubled over the study period, from 0·56 million (0·39-0·77) in 1990 to 1·02 million (0·71-1·38) in 2017. The age-standardised rate of DALYs decreased from 26·5 (21·0-33·0) per 100 000 population in 1990 to 23·2 (19·1-27·8) per 100 000 population in 2017.
Interpretation: The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease.
Funding: Bill & Melinda Gates Foundation.
Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
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References
- Sairenji T, Collins KL, Evans DV. An update on inflammatory bowel disease. Prim Care. 2017;44:673–692.
- Baumgart DC, Carding SR. Inflammatory bowel disease: cause and immunobiology. Lancet. 2007;369:1627–1640.
- Ng SC, Shi HY, Hamidi N. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390:2769–2778.
- Yang SK. How does the epidemiology of inflammatory bowel disease differ between east and west? A Korean perspective. Inflamm Intest Dis. 2017;2:95–101.
- GBD 2017 Cause of Death Collaborators Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–1788.
- GBD 2017 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–1858.
- Tontini GE, Vecchi M, Pastorelli L, Neurath MF, Neumann H. Differential diagnosis in inflammatory bowel disease colitis: state of the art and future perspectives. World J Gastroenterol. 2015;21:21–46.
- GBD 2016 Disease and Injury Incidence and Prevalence Collaborators; and others Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–1259.
- GBD 2017 Population and Fertility Collaborators Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1995–2051.
- Malik TA. Inflammatory bowel disease: historical perspective, epidemiology, and risk factors. Surg Clin North Am. 2015;95:1105–1122.
- Loftus EV., Jr Update on the incidence and prevalence of inflammatory bowel disease in the United States. Gastroenterol Hepatol. 2016;12:704–707.
- Stone MA, Mayberry JF, Baker R. Prevalence and management of inflammatory bowel disease: a cross-sectional study from central England. Eur J Gastroenterol Hepatol. 2003;15:1275–1280.
- Binder V. Epidemiology of IBD during the twentieth century: an integrated view. Best Pract Res Clin Gastroenterol. 2004;18:463–479.
- Economou M, Pappas G. New global map of Crohn's disease: genetic, environmental, and socioeconomic correlations. Inflamm Bowel Dis. 2008;14:709–720.
- Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2015;12:720–727.
- Bernstein CN, Kraut A, Blanchard JF, Rawsthorne P, Yu N, Walld R. The relationship between inflammatory bowel disease and socioeconomic variables. Am J Gastroenterol. 2001;96:2117–2125.
- Alexander KL, Targan SR, Elson CO., 3rd Microbiota activation and regulation of innate and adaptive immunity. Immunol Rev. 2014;260:206–220.
- Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology. 2014;146:1489–1499.
- Lovasz BD, Golovics PA, Vegh Z, Lakatos PL. New trends in inflammatory bowel disease epidemiology and disease course in Eastern Europe. Dig Liver Dis. 2013;45:269–276.
- Shouval DS, Rufo PA. The role of environmental factors in the pathogenesis of inflammatory bowel diseases: a review. JAMA Pediatr. 2017;171:999–1005.
- Abegunde AT, Muhammad BH, Bhatti O, Ali T. Environmental risk factors for inflammatory bowel diseases: Evidence based literature review. World J Gastroenterol. 2016;22:6296–6317.
- Rogler G, Bernstein CN, Sood A. Role of biological therapy for inflammatory bowel disease in developing countries. Gut. 2012;61:706–712.
- Burisch J, Jess T, Martinato M, Lakatos PL. The burden of inflammatory bowel disease in Europe. J Crohns Colitis. 2013;7:322–337.
- Kawalec P. Indirect costs of inflammatory bowel diseases: Crohn's disease and ulcerative colitis. A systematic review. Arch Med Sci. 2016;12:295–302.
- Dignass A, Lindsay JO, Sturm A. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis. 2012;6:991–1030.
- Dignass A, Van Assche G, Lindsay JO. The second European evidence-based consensus on the diagnosis and management of Crohn's disease: current management. J Crohns Colitis. 2010;4:28–62.
- Mikocka-Walus A, Pittet V, Rossel JB, von Kanel R. Symptoms of depression and anxiety are independently associated with clinical recurrence of inflammatory bowel disease. Clin Gastroenterol Hepatol. 2016;14:829–835.
- M'Koma AE. Inflammatory bowel disease: an expanding global health problem. Clin Med Insights Gastroenterol. 2013;6:33–47.
- Law ST, Li KK. Gender-related differences in clinical course of crohn's disease in an Asian population: a retrospective cohort review. Arq Gastroenterol. 2014;51:90–96.
- Sood A, Midha V, Sood N, Bhatia AS, Avasthi G. Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut. 2003;52:1587–1590.
- Khosla SN, Girdhar NK, Lal S, Mishra DS. Epidemiology of ulcerative colitis in hospital and select general population of northern India. J Assoc Physicians India. 1986;34:405–407.
- Ghoshal UC, Singh R. Frequency and risk factors of functional gastro-intestinal disorders in a rural Indian population. J Gastroenterol Hepatol. 2017;32:378–387.
- Benchimol EI, Manuel DG, Guttmann A. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm Bowel Dis. 2014;20:1761–1769.
Source: PubMed