. 2024 Aug 1;119(8):1563-1570.

doi: 10.14309/ajg.0000000000002687. Epub 2024 Feb 1.

Forecasting the Incidence and Prevalence of Inflammatory Bowel Disease: A Canadian Nationwide Analysis

Stephanie Coward¹, Eric I Benchimol^{2

3

4

5}, Charles N Bernstein⁶, Antonio Avina-Zubieta⁷, Alain Bitton⁸, Matthew W Carroll⁹, Yungsong Cui¹⁰, Frank Hoentjen¹¹, Lindsay Hracs¹, Kevan Jacobson¹², Jennifer L Jones¹³, James King¹, M Ellen Kuenzig^{4

14}, Na Lu¹⁵, Wael El-Matary¹⁶, Sanjay K Murthy¹⁷, Zoann Nugent¹⁸, Anthony R Otley¹⁹, Remo Panaccione¹, Juan Nicolás Peña-Sánchez²⁰, Harminder Singh^{21

22}, Laura E Targownik²³, Dominic White²⁴, Joseph W Windsor¹, Gilaad G Kaplan¹; Canadian Gastro-Intestinal Epidemiology Consortium (CanGIEC)

Affiliations

¹ Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
² SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.
³ Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁴ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
⁵ ICES, Toronto, Ontario, Canada.
⁶ Department of Medicine, and the University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁷ Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada.
⁸ Division of Gastroenterology and Hepatology, McGill University and McGill University Health Centre, Montreal, Quebec, Canada.
⁹ Division of Gastroenterology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
¹⁰ Atlantic PATH, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
¹¹ Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada.
¹² Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada.
¹³ Department of Medicine & Clinical Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁴ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁵ Arthritis Research Canada, Vancouver, British Columbia, Canada.
¹⁶ Department of Pediatrics, and the Children's Hospital Research Institute of Manitoba, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁷ The Ottawa Hospital IBD Centre and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁸ University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁹ Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
²⁰ Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Canada.
²¹ Departments of Medicine and Community Health Sciences, the University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
²² CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
²³ Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
²⁴ Newfoundland and Labrador Centre for Health Information, St. John's, Newfoundland, Canada.

PMID: 38299598
PMCID: PMC11288393
DOI: 10.14309/ajg.0000000000002687

Forecasting the Incidence and Prevalence of Inflammatory Bowel Disease: A Canadian Nationwide Analysis

Stephanie Coward et al. Am J Gastroenterol. 2024.

. 2024 Aug 1;119(8):1563-1570.

doi: 10.14309/ajg.0000000000002687. Epub 2024 Feb 1.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
² SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.
³ Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁴ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
⁵ ICES, Toronto, Ontario, Canada.
⁶ Department of Medicine, and the University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁷ Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada.
⁸ Division of Gastroenterology and Hepatology, McGill University and McGill University Health Centre, Montreal, Quebec, Canada.
⁹ Division of Gastroenterology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
¹⁰ Atlantic PATH, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
¹¹ Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada.
¹² Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital and British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada.
¹³ Department of Medicine & Clinical Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁴ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁵ Arthritis Research Canada, Vancouver, British Columbia, Canada.
¹⁶ Department of Pediatrics, and the Children's Hospital Research Institute of Manitoba, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁷ The Ottawa Hospital IBD Centre and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁸ University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁹ Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
²⁰ Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Canada.
²¹ Departments of Medicine and Community Health Sciences, the University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
²² CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
²³ Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
²⁴ Newfoundland and Labrador Centre for Health Information, St. John's, Newfoundland, Canada.

PMID: 38299598
PMCID: PMC11288393
DOI: 10.14309/ajg.0000000000002687

Abstract

Introduction: Canada has a high burden of inflammatory bowel disease (IBD). Historical trends of IBD incidence and prevalence were analyzed to forecast the Canadian burden over the next decade.

Methods: Population-based surveillance cohorts in 8 provinces derived from health administrative data assessed the national incidence (2007-2014) and prevalence (2002-2014) of IBD. Autoregressive integrated moving average models were used to forecast incidence and prevalence, stratified by age, with 95% prediction intervals (PI), to 2035. The average annual percentage change (AAPC) with 95% confidence interval (CI) was calculated for the forecasted incidence and prevalence.

Results: The national incidence of IBD is estimated to be 29.9 per 100,000 (95% PI 28.3-31.5) in 2023. With a stable AAPC of 0.36% (95% CI -0.05 to 0.72), the incidence of IBD is forecasted to be 31.2 per 100,000 (95% PI 28.1-34.3) in 2035. The incidence in pediatric patients (younger than 18 years) is increasing (AAPC 1.27%; 95% CI 0.82-1.67), but it is stable in adults (AAPC 0.26%; 95% CI -0.42 to 0.82). The prevalence of IBD in Canada was 843 per 100,000 (95% PI 716-735) in 2023 and is expected to steadily climb (AAPC 2.43%; 95% CI 2.32-2.54) to 1,098 per 100,000 (95% PI 1,068-1,127) by 2035. The highest prevalence is in seniors with IBD (1,174 per 100,000 in 2023; AAPC 2.78%; 95% CI 2.75-2.81).

Discussion: Over the next decade, the Canadian health care systems will contend with the juxtaposition of rising incidence of pediatric IBD and a rising prevalence of overall IBD driven by the aging population.

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Conflict of interest statement

Guarantor of the article: Gilaad G. Kaplan, MD, MPH.

Specific author contributions: S.C., E.I.B., C.N.B., A.A.Z., A.B., J.L.J., M.E.K., S.K.M., A.R.O., J.N.P.S., L.E.T., and G.G.K.: conception or design of the work. S.C., E.I.B., C.N.B., A.A.Z., A.B., J.L.J., M.E.K., S.K.M., A.R.O., J.N.P.S., L.E.T., G.G.K., Y.C., J.K., L.L., Z.N., and D.W.: acquisition of data. S.C., E.I.B., C.N.B., A.A.Z., A.B., J.L.J., M.E.K., S.K.M., A.R.O., J.N.P.S., L.E.T., G.G.K., and L.H.: analysis. S.C., E.I.B., C.N.B., A.A.Z., A.B., M.W.C., Y.C., F.H., L.H., K.J., J.L.J., J.K., M.E.K., L.L., W.E.M., S.K.M., Z.N., A.R.O., R.P., J.N.P.S., H.S., L.E.T., D.W., J.W.W., and G.G.K.: interpretation of data for the work. S.C. and G.G.K.: drafting the work. E.I.B., C.N.B., A.A.Z., A.B., M.W.C., Y.C., F.H., L.H., K.J., J.L.J., J.K., M.E.K., L.L., W.E.M., S.K.M., Z.N., A.R.O., R.P., J.N.P.S., H.S., L.E.T., D.W., and J.W.W.: reviewing the work critically for important intellectual content. S.C., E.I.B, C.N.B., A.A.Z., A.B., M.W.C., Y.C., F.H., L.H., K.J., J.L.J., J.K., M.E.K., L.L., W.E.M., S.K.M., Z.N., A.R.O., R.P., J.N.P.S., H.S., L.E.T., D.W., J.W.W., and G.G.K.: final approval of the manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Financial support: The Leona M. and Harry B. Helmsley Charitable Trust (grant number G-2108-04777). Canadian Institutes of Health Research, Project Scheme Operating Grant (reference number PJT-162393).

Potential competing interests: G.G.K. has received honoraria for speaking or consultancy from AbbVie, Amgen, Janssen, Pfizer, Sandoz, and Pendophram. G.G.K. received grants for research from Ferring and for educational activities from AbbVie, Bristol Myers Squibb, Ferring, Fresenius-Kabi, Janssen, Pfizer, and Takeda. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. September 7, 018. H.S. has been on advisory boards or consulted to Pendopharm, Amgen Canada, Bristol Myers Squibb Canada, Roche Canada, Sandoz Canada, Takeda Canada, and Guardant Health. He has also acted as a consultant for the Canadian Agency for Drugs and Technology in Health. He has received research funding from Pfizer Canada. C.N.B. has served on advisory Boards for AbbVie Canada, Amgen Canada, Bristol Myers Squibb Canada, Eli Lilly Canada, JAMP Pharmaceuticals, Roche Canada, Janssen Canada, Sandoz Canada, Takeda Canada, and Pfizer Canada. He has been a consultant for Takeda. He has received educational grants from AbbVie Canada, Bristol Myers Squibb, Pfizer Canada, Takeda Canada, and Janssen Canada. He is on speaker's panel for AbbVie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada. He has received research funding from AbbVie Canada, Amgen Canada, Sandoz Canada, Takeda Canada, and Pfizer Canada. R.P. has received consulting fees from Abbott, AbbVie, Alimentiv (formerly Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, Eli Lilly, Ferring, Galapagos, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pendopharm, Pfizer, Progenity, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, and Takeda. E.I.B. has acted as a consultant for McKesson Canada and the Dairy Farmers of Ontario for matters unrelated to medications used to treat inflammatory bowel disease. He has also acted as a consultant for the Canadian Agency for Drugs and Technology in Health (CADTH). A.R.O. has been on advisory boards of AbbVie Canada, Janssen Canada, and Nestle. He has received unrestricted educational grants from AbbVie Canada and Janssen Canada. His site is involved with clinical trials for AbbVie, Pfizer, Takeda, Eli Lily, and Celgene. L.E.T. has received investigator-initiated funding from Janssen Canada and served on advisory boards for AbbVie Canada, Sandoz Canada, Takeda Canada, Merck Canada, Pfizer Canada, Janssen Canada, and Roche Canada. A.B. has been a member of Advisory Boards: AbbVie, Pfizer, Takeda, Janssen, McKesson, Biojamp, Frenesius Kabi, Bristol Myers Squibb, and Amgen; educational activities: AbbVie, Janssen, Takeda, and Viatris. J.L.J. reports advisory board fees from AbbVie, Janssen, Pfizer, and Ferring; speaker's fees from AbbVie, Janssen, and Takeda; and research support from AbbVie, Janssen, and Pfizer. F.H. has served on advisory boards or as speaker for AbbVie, Janssen, MSD, Takeda, Pfizer, Celltrion, Teva, Sandoz, and Pendopharm and has received independent research funding from Janssen, AbbVie, Pfizer, and Takeda. M.W.C. has received speaker fees from AbbVie and Janssen. K.J. has been on advisory boards of AbbVie Canada, Janssen Canada, Amgen, Merck, Viatris, and Mckesson Canada. He is on the speaker's bureau for AbbVie Canada and Janssen Canada. He has investigator-initiated research support from Janssen and Stock options from Engene. The remaining authors report no conflicts of interest. This study is based partly on deidentified data provided by the Saskatchewan Ministry of Health and eHealth Saskatchewan. The interpretation and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan, the Saskatchewan Ministry of Health, or eHealth Saskatchewan. This study is based partly on deidentified data provided by Alberta Health Services, Régie de l'assurance maladie du Québec, Ministry of Health of British Columbia and Population Data BC, Saskatchewan Ministry of Health, Health Data Nova Scotia of Dalhousie University, Manitoba Health, and Newfoundland and Labrador Centre for Health Information. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Alberta, Government of Quebec, Government of British Columbia, Government of Saskatchewan or the Ministry of Health, Health Data Nova Scotia or the Department of Health and Wellness, or the Government of Manitoba, or the Government of Newfoundland & Labrador. Neither the Government of Alberta nor Alberta Health Services expressed any opinion in relation to this study. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results, and conclusions reported in this study are those of the authors and are independent from the funding sources. No endorsement by Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. The interpretation and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan or the Ministry of Health. Although this research and health service assessment analysis is based on data obtained from the Nova Scotia Department of Health and Wellness, the observations and opinions expressed are those of the authors and do not represent those of Health Data Nova Scotia or the Department of Health and Wellness.

Availability of data, code, and other materials: All aggregate data reported are provided in an open access online interactive map: https://kaplan-gi.shinyapps.io/Canada_inc_prev/.

Figures

**Figure 1.**
Actual and forecasted incidence (a) and prevalence (b) of IBD in Canada by province. Actual incidence and prevalence, standardized for age and sex, is denoted by the solid line. Forecasted incidence and prevalence, analyzed with an ARIMA model and then forecasted until 2035, is indicated by a dashed line with the prediction intervals highlighted. All aggregate data reported are provided in an open access online interactive map: https://kaplan-gi.shinyapps.io/Canada_inc_prev/. AB, Alberta; ARIMA, autoregressive integrated moving average; BC, British Columbia; IBD, inflammatory bowel disease; MB, Manitoba; NL, Newfoundland; NS, Nova Scotia; ON, Ontario; QS, Quebec; SK, Saskatchewan.

**Figure 2.**
Actual and forecasted national estimates for incidence (a) and prevalence (b) for all ages and stratified by pediatric-onset, adult-onset, and senior-onset IBD. Actual incidence and prevalence, standardized for age and sex, is denoted by the solid line. Forecasted incidence and prevalence, analyzed with an ARIMA model and then forecasted until 2035, is indicated by a dashed line with the prediction intervals highlighted. All aggregate data reported are provided in an open access online interactive map: https://kaplan-gi.shinyapps.io/Canada_inc_prev/. ARIMA, autoregressive integrated moving average; IBD, inflammatory bowel disease.

See this image and copyright information in PMC

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Forecasting the Incidence and Prevalence of Inflammatory Bowel Disease: A Canadian Nationwide Analysis

Affiliations

Forecasting the Incidence and Prevalence of Inflammatory Bowel Disease: A Canadian Nationwide Analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

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Full Text Sources

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