Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019

Abstract

Objectives: We aimed to provide the most updated estimates on the global burden of inflammatory bowel disease (IBD) to improve management strategies.

Design: We extracted data from the Global Burden of Disease (GBD) 2019 database to evaluate IBD burden with different measures in 204 countries and territories from 1990 to 2019.

Setting: Studies from the GBD 2019 database generated by population-representative data sources identified through a literature review and research collaborations were included.

Participants: Patients with an IBD diagnosis.

Outcomes: Total numbers, age-standardised rates of prevalence, mortality and disability-adjusted life-years (DALYs), and their estimated annual percentage changes (EAPCs) were the main outcomes.

Results: In 2019, there were approximately 4.9 million cases of IBD worldwide, with China and the USA having the highest number of cases (911 405 and 762 890 (66.9 and 245.3 cases per 100 000 people, respectively)). Between 1990 and 2019, the global age-standardised rates of prevalence, deaths and DALYs decreased (EAPCs=-0.66,-0.69 and -1.04, respectively). However, the age-standardised prevalence rate increased in 13 out of 21 GBD regions. A total of 147 out of 204 countries or territories experienced an increase in the age-standardised prevalence rate. From 1990 to 2019, IBD prevalent cases, deaths and DALYs were higher among females than among males. A higher Socio-demographic Index was associated with higher age-standardised prevalence rates.

Conclusions: IBD will continue to be a major public health burden due to increasing numbers of prevalent cases, deaths and DALYs. The epidemiological trends and disease burden of IBD have changed dramatically at the regional and national levels, so understanding these changes would be beneficial for policy makers to tackle IBD.

Keywords: EPIDEMIOLOGY; Gastroenterology; Inflammatory bowel disease.

Figure 1

The global prevalence burden of IBD in 204 countries and territories. (A) The absolute number of IBD prevalent cases in 2019. (B) The age-standardised prevalence rate (per 100 000 population) of IBD in 2019. (C) The EAPC of age-standardised prevalence rate for IBD between 1990 and 2019. EAPC, estimated annual percentage change; IBD, inflammatory bowel disease.

Figure 2

The EAPCs in age-standardised rates of prevalence (A, B), deaths (C, D), and DALYs (E, F) due to IBD from 1990 to 2019, both sexes, by GBD region and by SDI quintile. DALYs, disability-adjusted life-years; EAPC, estimated annual percentage change; GBD, Global Burden of Disease; IBD, inflammatory bowel disease; SDI, Socio-demographic Index.

Figure 3

The age-standardised rates of prevalence (A), deaths (B), and DALYs (C) due to IBD by sex, across 21 regions, in 2019. Error bars indicate the 95% uncertainty interval (UI) for the age-standardised rates. DALYs, disability-adjusted life-years; GBD, Global Burden of Disease; IBD, inflammatory bowel disease.

Figure 4

The absolute number of prevalent cases (A), deaths (B), and DALYs (C) due to IBD for all GBD regions from 1990 to 2019. DALYs, disability-adjusted life-years; GBD, Global Burden of Disease; IBD, inflammatory bowel disease.

Figure 5

Age patterns by sex of the total number and age-standardised rates of prevalent cases (A), deaths (B) and DALYs (C) due to IBD at the global level in 2019. Error bars indicate the 95% uncertainty interval (UI) for the number of cases. Shading indicates the 95% UI for the rates. DALYs, disability-adjusted life-years; IBD, inflammatory bowel disease.

Figure 6

The age-standardised rates of IBD prevalence (A), deaths (B), and DALYs globally and for 21 GBD regions by SDI from 1990 to 2019. The expected age-standardised rates in 2019 based solely on SDI were represented by the black line. For each region, points from left to right depict estimates from each year from 1990 to 2019. DALYs, disability-adjusted life-years; GBD, Global Burden of Disease; IBD, inflammatory bowel disease; SDI, Socio-demographic Index.