The 2023 Impact of Inflammatory Bowel Disease in Canada: Epidemiology of IBD

Stephanie Coward¹, Eric I Benchimol^{2

3

4

5

6}, M Ellen Kuenzig^{2

3}, Joseph W Windsor¹, Charles N Bernstein^{7

8}, Alain Bitton⁹, Jennifer L Jones¹⁰, Kate Lee¹¹, Sanjay K Murthy^{12

13}, Laura E Targownik¹⁴, Juan-Nicolás Peña-Sánchez¹⁵, Noelle Rohatinsky¹⁶, Sara Ghandeharian¹¹, James H B Im^{2

3}, Tal Davis^{2

3}, Jake Weinstein^{2

3}, Quinn Goddard¹, Jennifer Bennett¹¹, Léa Caplan¹, Maxime Bergevin^{17

18}, Xin Yu Yang¹¹, Kate Mason¹¹, Rhonda Sanderson¹⁹, Colten Brass²⁰, Gilaad G Kaplan¹

Affiliations

¹ Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
² SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
³ Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ ICES, Toronto, Ontario, Canada.
⁵ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁸ University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
⁹ Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada.
¹⁰ Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹¹ Crohn's and Colitis Canada, Toronto, Ontario, Canada.
¹² Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹³ The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
¹⁴ Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
¹⁵ Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁶ College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁷ École de kinésiologie et des sciences de l'activité physique, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.
¹⁸ Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada.
¹⁹ James Smith Cree Nation, Saskatchewan, Canada.
²⁰ Muskoday First Nation, Saskatchewan, Canada.

PMID: 37674492
PMCID: PMC10478802
DOI: 10.1093/jcag/gwad004

Review

The 2023 Impact of Inflammatory Bowel Disease in Canada: Epidemiology of IBD

Stephanie Coward et al. J Can Assoc Gastroenterol. 2023.

. 2023 Sep 5;6(Suppl 2):S9-S15.

doi: 10.1093/jcag/gwad004. eCollection 2023 Sep.

Authors

Affiliations

¹ Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
² SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
³ Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ ICES, Toronto, Ontario, Canada.
⁵ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁸ University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
⁹ Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada.
¹⁰ Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹¹ Crohn's and Colitis Canada, Toronto, Ontario, Canada.
¹² Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹³ The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada.
¹⁴ Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
¹⁵ Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁶ College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁷ École de kinésiologie et des sciences de l'activité physique, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.
¹⁸ Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada.
¹⁹ James Smith Cree Nation, Saskatchewan, Canada.
²⁰ Muskoday First Nation, Saskatchewan, Canada.

PMID: 37674492
PMCID: PMC10478802
DOI: 10.1093/jcag/gwad004

Erratum in

Correction to: The 2023 Impact of Inflammatory Bowel Disease in Canada: Epidemiology of IBD.
[No authors listed] [No authors listed] J Can Assoc Gastroenterol. 2023 Nov 1;6(6):256. doi: 10.1093/jcag/gwad043. eCollection 2023 Dec. J Can Assoc Gastroenterol. 2023. PMID: 38106486 Free PMC article.

Abstract

Inflammatory bowel disease (IBD), consisting of Crohn's disease and ulcerative colitis, is recognized across the world, though Canada has among the highest burdens of IBD in the world. The Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC) led a six-province study that demonstrated the compounding prevalence of IBD in Canada from 400 per 100,000 in 2002 to 636 per 100,000 in 2014. The prevalence in 2023 is estimated at 825 per 100,000, meaning that over 320,000 people in Canada are living with IBD. Prevalence is forecasted to rise by 2.44% per year such that 1.1% of the population, 470,000 Canadians, will live with IBD by 2035. The overall incidence of IBD in 2023 is 30 per 100,000 person-years, indicating that over 11,000 Canadians will be newly diagnosed with IBD in 2023. Incidence is forecasted to rise by 0.58% per year up to 32.1 per 100,000 by 2035. The rising incidence of IBD is propelled by pediatric-onset IBD, which is rising by 1.23% per year from 15.6 per 100,000 in 2023 to 18.0 per 100,000 in 2035. In contrast, incidence rates among adults and seniors are relatively stable. Understanding the determinates of IBD has expanded through prospective cohort studies such as the Crohn's and Colitis Canada Genetic, Environmental, Microbial (CCC-GEM) project. Consensus recommendations towards diet, lifestyle, behavioural and environmental modifications have been proposed by international organizations with the goal of optimizing disease control and ultimately preventing the development of IBD. Despite these efforts, Canadian healthcare systems will need to prepare for the rising number of people living with IBD.

Keywords: Crohn’s disease; Epidemiology trends; Incidence; Prevalence; Ulcerative colitis.

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Conflict of interest statement

Eric Benchimol holds the Northbridge Financial Corporation Chair in Inflammatory Bowel Disease, a joint Hospital-University Chair between the University of Toronto, The Hospital for Sick Children and the SickKids Foundation. He has acted as a consultant for the Dairy Farmers of Ontario and McKesson Canada for matters unrelated to medications used to treat inflammatory bowel disease. He is the Past Chair of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada and Editor-in-Chief of the Journal of the Canadian Association of Gastroenterology (JCAG). Ellen Kuenzig is a member of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Charles Bernstein is supported in part by the Bingham Chair in Gastroenterology. He is on Advisory Boards for AbbVie Canada, Amgen Canada, Bristol Myers Squibb, JAMP Pharmaceuticals, Lilly Canada, Janssen Canada, Pfizer Canada, Roche Canada, Sandoz Canada, Takeda Canada. He is a Consultant for Mylan Pharmaceuticals and Takeda. He has received educational grants from AbbVie Canada, Pfizer Canada, Takeda Canada, Janssen Canada and Bristol Myers Squibb Canada. He is on the speaker’s panel for AbbVie Canada, Janssen Canada, Pfizer Canada and Takeda Canada. Received research funding from AbbVie Canada, Amgen Canada, Pfizer Canada, Sandoz Canada. Alain Bitton has participated in advisory boards with AbbVie, Janssen, Takeda, McKesson, BioJamp, Bristol Myers Squibb Hoffman-LaRoche, Amgen. He has received research support from AbbVie. He is on the speaker’s panel for Janssen, Takeda, AbbVie, has participated in educational activities supported by Viatris and has received educational support from Fresenius Kabi, Amgen and Takeda. Jennifer Jones has received honoraria for speaking and consulting for AbbVie, Janssen, Pfizer, Shire and Takeda. She is the co-chair of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Kate Lee has received honoraria from AbbVie Corporation and Bristol Myers Squibb Canada. Sanjay Murthy has previously participated in advisory board meetings for AbbVie, Janssen, Takeda, Pfizer, Shire and Ferring and as a speaker at educational events sponsored by Janssen, AbbVie and Pfizer. Laura Targownik has received research funding from AbbVie Canada, Takeda Canada, Sandoz Canada, Amgen Canada, Gilead Canada, Roche Canada and Pfizer Canada, and has been on Advisory Boards for Janssen Canada, AbbVie Canada, Takeda Canada, Pfizer Canada, Merck Canada, Roche Canada, Sandoz Canada, Organon Canada, Fresesnius Kabi Canada, Eli Lilly Canada and Amgen Canada. She is a member of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Gilaad Kaplan has received honoraria for speaking or consultancy from AbbVie, Janssen, Pfizer and Takeda. He has received research support from Ferring, Janssen, AbbVie, GlaxoSmith Kline, Merck and Shire. He has been a consultant for Gilead. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. 7 September 2018. He is a member of the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada. Léa Caplan has received an AbbVie IBD scholarship. Xin Yu Yang has received an AbbVie IBD scholarship. Kate Mason has received an AbbVie IBD scholarship. None: Stephanie Coward, Joseph Windsor, Juan-Nicolás Peña-Sánchez, Tal Davis, Noelle Rohatinsky, Sara Ghandeharian, James Im, Jake Weinstein, Quinn Goddard, Jennifer Bennett, Maxime Bergevin, Rhonda Sanderson and Colton Brass.

Figures

**Figure 1.**
This figure depicts a stylized track of incidence and prevalence rates in each of the four epidemiologic stages. In Stage 1, Emergence, there is very low incidence due to sporadic disease. In Stage 2, Acceleration in Incidence, incidence rates quickly increase, and prevalence starts to accumulate. In Stage 3, Compounding Prevalence, incidence stabilizes but prevalence continues to climb. In Stage 4, Prevalence Equilibrium, the prevalence of disease begins to stabilize due to stable incidence and an aging population. Every region of the world is currently in one of the first three stages, as depicted by colours in the background map. No region has yet transitioned to Stage 4. (Adapted from Kaplan & Windsor 2021, updated with data from Windsor et al. 2023.)

See this image and copyright information in PMC

References

1. Kaplan GG, Ng SC. Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology 2017;152:313–21.e2. doi:10.1053/j.gastro.2016.10.020. - DOI - PubMed
1. Sazonovs A, Stevens CR, Venkataraman GR, et al. ; Belgium IBD Consortium. Large-scale sequencing identifies multiple genes and rare variants associated with Crohn’s disease susceptibility. Nat Genet 2022;54:1275–83. doi:10.1038/s41588-022-01156-2. - DOI - PMC - PubMed
1. Jostins L, Ripke S, Weersma RK, et al. ; International IBD Genetics Consortium (IIBDGC). Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature 2012;491:119–24. doi:10.1038/nature11582. - DOI - PMC - PubMed
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1. Kaplan GG. The global burden of IBD: From 2015 to 2025. Nat Rev Gastroenterol Hepatol 2015;12:720–7. doi:10.1038/nrgastro.2015.150. - DOI - PubMed

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The 2023 Impact of Inflammatory Bowel Disease in Canada: Epidemiology of IBD

Affiliations

The 2023 Impact of Inflammatory Bowel Disease in Canada: Epidemiology of IBD

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

Publication types

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Medical

Research Materials