Global burden of inflammatory bowel disease 1990-2019: A systematic examination of the disease burden and twenty-year forecast

Abstract

Background: Inflammatory bowel disease (IBD) is an idiopathic intestinal disease with various levels and trends in different countries and regions. Understanding the current burden and trends of IBD in various geographical locations is essential to establish effective strategies for prevention and treatment. We report the average annual percentage change (AAPC) and estimated annual percentage change (EAPC) in age-standardized rates (ASR) of IBD in different regions based on the Global Burden of Disease (GBD) study from 1990-2019, and the relationships between IBD and the human development index (HDI) and socio-demographic index (SDI). The prevalence trends of IBD were predicted by gender from 2019-2039.

Aim: To comprehensively investigate IBD data, providing further insights into the management of this chronic disease.

Methods: We collected the information on the incidence of IBD from the GBD study from 1990-2019 to calculate the AAPC and EAPC in ASR of IBD in different regions. The relationships between IBD, HDI, and SDI were analyzed. The Nordpred and Bayesian age-period-cohort models were used to predict the prevalence trends of IBD by gender from 2019-2039, and the reliability of the results was validated. Statistics of all the data in this study were performed using R software (version 4.2.1).

Results: North America consistently had the highest IBD ASR, while Oceania consistently had the lowest. East Asia had the fastest average annual growth in ASR (2.54%), whereas Central Europe had the fastest decline (1.38%). Countries with a low age-standardized incidence rates in 1990 showed faster growth in IBD while there was no significant correlation in 2019. Additionally, IBD increased faster in countries with a low age-standardized death rates in 1990, whereas the opposite was true in 2019. Analysis of SDI and IBD ASR showed that countries with a high SDI generally had a higher IBD ASR. Finally, the projections showed a declining trend in the incidence of IBD from 2019-2039, but a gradual increase in the number of cases.

Conclusion: As the global population increases and ages, early monitoring and prevention of IBD is important to reduce the disease burden, especially in countries with a high incidence of IBD.

Keywords: Age-standardized rates; Average annual percentage change; Global Burden of Disease; Incidence; Inflammatory bowel disease; Prevalence trends.

Figure 1

Inflammatory bowel disease burden in 204 countries and territories worldwide. A: Inflammatory bowel disease (IBD) age standardized rate (ASR) in 2019; B: Changes in the incidence of IBD from 1990-2019; C: Estimated annual percent change analysis of IBD ASR from 1990-2019. IBD: Inflammatory bowel disease; ASR: Age-standardized rate; EAPC: Estimated annual percent change.

Figure 2

Cluster analysis: Estimated annual percent change data combining incidence and deaths.

Figure 3

Correlation of estimated annual percent change with inflammatory bowel disease age standardized rate and human development index. A: Correlation of estimated annual percent change (EAPC) with inflammatory bowel disease (IBD) age-standardized incidence rates (ASIR) and age-standardized death rates (ASDR) in 1990; B: Correlation of EAPC with IBD ASIR and ASDR in 2019; C: Correlation of EAPC with human development index in 2019. The circles in the figure represent countries, and the size of the circles represents the number of IBD cases. ρ and P values were obtained using the Pearson correlation coefficient analysis. EAPC: Estimated annual percent change; ASR: Age standardized rate; HDI: Human development index.

Figure 4

Trends in inflammatory bowel disease age standardized rate by sociodemographic index from 1990-2019. A: Twenty-one Global Burden of Diseases regions are shown; B: 204 countries and territories are shown. The expected values for sociodemographic indices and disease incidence based on all sites are shown as black lines. ASR: Age standardized rate; SDI: Socio-demographic index.

Figure 5

Statistics and predictions of the number of cases in all age groups. A: Prediction based on Nordpred model; B: Prediction based on Bayesian age-period-cohort model.

Figure 6

Inflammatory bowel disease incidence from 1990-2019 and projections for the next 20 years, stratified by gender. A: Statistics and projections of the number of female patients with inflammatory bowel disease (IBD) are shown; B: Statistics and predictions of the female incidence of IBD are shown; C: Statistics and projections of the number of male patients with IBD are shown; D: Statistics and predictions of the male incidence of IBD are shown. Prediction of changes over the next 20 years are based on the Nordpred model.

Figure 7

Statistics and predictions of inflammatory bowel disease age standardized rate for different genders. A and B: The age standardized rate (ASR) statistics and predictions based on the Nordpred model for female and male, respectively; C and D: The ASR statistics and predictions for female and male based on the Bayesian age-period-cohort model, respectively. ASR: Age standardized rate.