The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Abstract

Background The burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017.Methods We modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95% uncertainty intervals (UI). Findings In 2017, there were 6•8 million (95% UI 6•4-7•3) cases of IBD globally. The age-standardised prevalence rate increased from 79•5 (75•9-83•5) per 100 000 population in 1990 to 84•3 (79•2-89•9) per 100 000 population in 2017. The age-standardised death rate decreased from 0•61 (0•55-0•69) per 100 000 population in 1990 to 0•51 (0•42-0•54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422•0 [398•7-446•1] per 100 000) and the lowest agestandardised prevalence rates were observed in the Caribbean (6•7 [6•3-7•2] per 100 000 population). High Sociodemographic Index (SDI) locations had the highest age-standardised prevalence rate, while low SDI regions had the lowest age-standardised prevalence rate. At the national level, the USA had the highest age-standardised prevalence rate (464•5 [438•6-490•9] per 100 000 population), followed by the UK (449•6 [420•6-481•6] per 100 000). Vanuatu had the highest age-standardised death rate in 2017 (1•8 [0•8-3•2] per 100 000 population) and Singapore had the lowest (0•08 [0•06-0•14] per 100 000 population). The total YLDs attributed to IBD almost doubled over the study period, from 0•56 million (0•39-0•77) in 1990 to 1•02 million (0•71-1•38) in 2017. The agestandardised rate of DALYs decreased from 26•5 (21•0-33•0) per 100 000 population in 1990 to 23•2 (19•1-27•8) per 100 000 population in 2017.Interpretation The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease.Funding Bill & Melinda Gates Foundation.

Adipose stem cells from patients with Crohn’s disease show a distinctive DNA methylation pattern

“…The prevalence of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis, is increasing, especially in western countries, and it is likely to represent an important social and economic burden in the coming years [1,2]. CD is characterized by persistent inflammation and ulcerations at the small or large bowel, provoking chronic low-grade systemic inflammation and an undulating course of activity, with relapsing cycles occurring after periods of remission.…”

Colonic Mucosal Microbiota and Association of Bacterial Taxa with the Expression of Host Antimicrobial Peptides in Pediatric Ulcerative Colitis

“…Inflammatory bowel diseases (IBD) affect up to seven million people globally and three million in Europe and their incidence and prevalence are increasing [ 1 , 2 ]. The two main conditions of IBD are ulcerative colitis (UC) and Crohn’s disease (CD).…”

“…The two main conditions of IBD are ulcerative colitis (UC) and Crohn’s disease (CD). Epidemiological patterns suggest that IBD will emerge as a major worldwide disease in the coming years [ 1 , 2 ]. The etiology of IBD is multifactorial and the course of pathogenesis is still largely unknown.…”

“…The growing incidence of IBD suggests that environmental factors that have changed during the past decades, such as urbanization, hygienic conditions and microbial exposure, use of chemicals, diet, smoking and the use of antibiotics and other medication, modify the disease risk of genetically predisposed individuals [ 1 , 2 , 8 ]. Microbiota are a major dictator of the antigenic milieu in the intestine and also have a regulatory effect on the host gene expression in the mucosa, and therefore can affect immunological balance in the gut epithelium [ 9 , 10 , 11 , 12 ].…”

Physical activity shapes the intestinal microbiome and immunity of healthy mice but has no protective effects against colitis in MUC2-/- mice

“…With incidence of IBD and its burdens rising globally (5), there is an increasing demand 50 for novel therapeutics. Physical activity (PA) has been proposed as both a primary and an 51 adjunct therapy for prevention and treatment of various chronic diseases due to its well 52 documented ability to ameliorate low-grade systemic inflammation (6).…”