Epidemiological analysis reveals a surge in inflammatory bowel disease among children and adolescents: A global, regional, and national perspective from 1990 to 2019 - insights from the China study

Abstract

Background: The burden of inflammatory bowel disease (IBD) among children and adolescents is rising globally, with substantial variation in levels and trends of disease in different countries and regions, while data on the burden and trends were sparse in children and adolescents. We aimed to assess the trends and geographical differences in children and adolescents aged zero to 19 in 204 countries and territories over the past 30 years.

Methods: Data on IBD among children and adolescents was collected from the Global Burden of Disease (GBD) 2019 database from 1990 to 2019. We used the GBD data and methodologies to describe the change in the burden of IBD among children and adolescents involving prevalence, incidence, disability-adjusted life years (DALYs), and mortality.

Results: Globally, the IBD prevalence cases increased between 1990 and 2019. Annual percentage changes (AAPC) = 0.15; 95% confidence interval (CI) = 0.11-0.19, and incidence cases of IBD increased from 20 897.4 (95% CI = 17 008.6-25 520.2 in 1990 to 25 658.6 (95% CI = 21 268.5-31 075.6) in 2019, representing a 22.78% increase, DALYs cases decreased between 1990 and 2019 (AAPC = -3.02; 95% CI = -3.15 to -2.89), and mortality cases of IBD decreased from 2756.5 (95% CI = 1162.6-4484.9) in 1990 to 1208.0 (95% CI = 802.4-1651.4) in 2019, representing a 56.17% decrease. Decomposition analysis showed that IBD prevalence and incidence increased significantly, and a trend exhibited a decrease in underlying age and population-adjusted IBD DALYs and mortality rates. Correlation analysis showed that countries with high health care quality and access (HAQ) had relatively higher IBD age-standardised prevalence rate (ASPR) and age-standardised incidence rate (ASIR), but lower age-standardised DALYs rate (ASDR) and age-standardised mortality rate (ASMR).

Conclusions: Global prevalence and incidence rate of IBD among children and adolescents have been increasing from 1990 to 2019, while the DALYs and mortality have been decreasing. Rising prevalence and rising incidence in areas with historically low rates will have crucial health and economic implications.

Figure 1

Geographical distribution of IBD prevalence, incidence, DALYs and mortality in children and adolescents in 204 countries and territories. Panel A. Worldwide prevalence of inflammatory bowel disease (IBD). Panel B. Worldwide incidence of IBD. Panel C. Worldwide DALYs of IBD. Panel D. Worldwide mortality of IBD.

Figure 2

Changes in IBD prevalence, incidence, DALYs and mortality according to population-level determinants of ageing, population growth, and epidemiological change from 1990 to 2019 at the global level and by SDI quintile. Panel A. Prevalence. Panel B. Incidence. Panel C. Disability-adjusted life-years (DALYs). Panel D. Mortality. The black dot represents the overall value of change contributed by all 3 components. For each component, the magnitude of a positive value indicates a corresponding increase in IBD attributed to the component; the magnitude of a negative value indicates a corresponding decrease in IBD attributed to the related component.

Figure 3

Association between age-standardised IBD prevalence, incidence, DALYs and mortality rate and HAQ index. Each circle represents a country. Circles are colored according to SDI quintile. Circle size corresponds to population number.

Figure 4

Frontier analysis based on SDI and DALY of IBD in children and adolescents in 204 countries and territories. Panel A. Frontier analysis based on SDI and age-standardised IBD DALY rate from 1990 to 2019. Color scale represents the years from 1990 depicted in blue to 2019 depicted in gray. Solid black color to delineate the frontier. Panel B. Frontier analysis based on SDI and age-standardised IBD DALY rate in 2019. Dots represent countries and territories. The frontier is delineated in solid black color. Black fonts are used to label the top 15 countries with the largest effective difference (largest IBD DALY gap from the frontier). Examples of countries and territories with high SDI (>0.85) and relatively high effective difference for their level of development are labeled in red (e.g. USA, Norway, Japan, Denmark, and Canada), and blue fonts are used to label examples of frontier countries with low SDI (<0.5) and low effective difference (e.g. Somalia, Burundi, Vanuatu, Papua New Guinea, Solomon Islands). Red dots indicate a decrease in age-standardised IBD DALY rate from 1990 to 2019; blue dots indicate an increase in age-standardised IBD DALY rate from 1990 to 2019.