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The global burden of IBD: from 2015 to 2025

Nature Reviews Gastroenterology & Hepatology volume 12, pages 720–727 (2015)Cite this article

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Abstract

Over 1 million residents in the USA and 2.5 million in Europe are estimated to have IBD, with substantial costs for health care. These estimates do not factor in the 'real' price of IBD, which can impede career aspirations, instil social stigma and impair quality of life in patients. The majority of patients are diagnosed early in life and the incidence continues to rise; therefore, the effect of IBD on health-care systems will rise exponentially. Moreover, IBD has emerged in newly industrialized countries in Asia, South America and Middle East and has evolved into a global disease with rising prevalence in every continent. Understanding the worldwide epidemiological patterns of IBD will prepare us to manage the burden of IBD over time. The goal of this article is to establish the current epidemiology of IBD in the Western world, contrast it with the increase in IBD in newly industrialized countries and forecast the global effects of IBD in 2025.

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Figure 1
Figure 2: The global prevalence of IBD in 2015.

References

  1. Kirsner, J. B. Historical aspects of inflammatory bowel disease. J. Clin. Gastroenterol. 10, 286–297 (1988).

    Article  CAS  PubMed  Google Scholar 

  2. Kirsner, J. B. Historical origins of current IBD concepts. World J. Gastroenterol. 7, 175–184 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Mulder, D. J., Noble, A. J., Justinich, C. J. & Duffin, J. M. A tale of two diseases: the history of inflammatory bowel disease. J. Crohns Colitis 8, 341–348 (2014).

    Article  PubMed  Google Scholar 

  4. Molodecky, N. A. et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142, 46–54. e42 (2012).

    Article  PubMed  Google Scholar 

  5. Wilks, S. Morbid appearances in the intestine of Miss Bankes. London Medical Gazette 2, 264–265 (1859).

    Google Scholar 

  6. Wilks, S. & Moxon, W. Lectures on Pathological Anatomy. 2nd ed. (Longmans, 1875).

    Google Scholar 

  7. Lockhart-Mummery, J. P. A discussion on ulcerative colitis. Proc. R. Soc. Med. 2, 92–94 (1909).

    Google Scholar 

  8. Crohn, B. B., Ginzburg, L. & Oppenheimer, G. D. Regional ileitis: a pathologic and clinical entity. JAMA 99, 1323–1329 (1932).

    Article  Google Scholar 

  9. Benchimol, E. I. et al. Increasing incidence of paediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data. Gut 58, 1490–1497 (2009).

    Article  CAS  PubMed  Google Scholar 

  10. Benchimol, E. I. et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm. Bowel Dis. 20, 1761–1769 (2014).

    Article  PubMed  Google Scholar 

  11. Loftus, E. V., Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology 126, 1504–1517 (2004).

    Article  PubMed  Google Scholar 

  12. Kappelman, M. D. et al. Direct health care costs of Crohn's disease and ulcerative colitis in US children and adults. Gastroenterology 135, 1907–1913 (2008).

    Article  PubMed  Google Scholar 

  13. Kappelman, M., Moore, K., Allen, J. & Cook, S. Recent trends in the prevalence of Crohn's disease and ulcerative colitis in a commercially insured US population. Dig. Dis. Sci. 58, 519–525 (2013).

    Article  PubMed  Google Scholar 

  14. Rocchi, A. et al. Inflammatory bowel disease: a Canadian burden of illness review. Can. J. Gastroenterol. 26, 811–817 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Burisch, J., Jess, T., Martinato, M. & Lakatos, P. L. The burden of inflammatory bowel disease in Europe. J. Crohns Colitis 7, 322–337 (2013).

    Article  PubMed  Google Scholar 

  16. Frolkis, A. D. et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology 145, 996–1006 (2013).

    Article  PubMed  Google Scholar 

  17. Frolkis, A. D. et al. Cumulative incidence of second intestinal resection in Crohn's disease: a systematic review and meta-analysis of population-based studies. Am. J. Gastroenterol. 109, 1739–1748 (2014).

    PubMed  Google Scholar 

  18. Marchetti, M. & Liberato, N. L. Biological therapies in Crohn's disease: are they cost-effective? A critical appraisal of model-based analyses. Expert Rev. Pharmacoecon. Outcomes Res. 14, 815–824 (2014).

    Article  PubMed  Google Scholar 

  19. Park, S. J., Kim, W. H. & Cheon, J. H. Clinical characteristics and treatment of inflammatory bowel disease: a comparison of Eastern and Western perspectives. World J. Gastroenterol. 20, 11525–11537 (2014).

    Google Scholar 

  20. Ng, S. C. Emerging Leadership Lecture: Inflammatory bowel disease in Asia: emergence of a “Western Disease”. J. Gastroenterol. Hepatol. 30, 440–445 (2015).

    Article  CAS  PubMed  Google Scholar 

  21. Ng, S. C. et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. Gastroenterology 145, 158–165. e152 (2013).

    Article  PubMed  Google Scholar 

  22. Sood, A., Midha, V., Sood, N., Bhatia, A. S. & Avasthi, G. Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut 52, 1587–1590 (2003).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Tozun, N. et al. Clinical characteristics of inflammatory bowel disease in Turkey: a multicenter epidemiologic survey. J. Clin. Gastroenterol. 43, 51–57 (2009).

    Article  PubMed  Google Scholar 

  24. Victoria, C. R., Sassak, L. Y. & Nunes, H. R. Incidence and prevalence rates of inflammatory bowel diseases, in midwestern of Sao Paulo State, Brazil. Arq Gastroenterol. 46, 20–25 (2009).

    Article  PubMed  Google Scholar 

  25. Crafts, N. Productivity growth in the industrial revolution: A new growth accounting perspective. J. Econom. History 64, 521–535 (2004).

    Google Scholar 

  26. Bach, J. F. The effect of infections on susceptibility to autoimmune and allergic diseases. N. Engl. J. Med. 347, 911–920 (2002).

    Article  PubMed  Google Scholar 

  27. Burisch, J. et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 63, 588–597 (2014).

    Article  CAS  PubMed  Google Scholar 

  28. Vegh, Z. et al. Incidence and initial disease course of inflammatory bowel diseases in in Europe and Australia: results of the 2011 ECCO-EpiCom inception cohort. J. Crohns Colitis 8, 1506–1515 (2011).

    Article  Google Scholar 

  29. Bitton, A. et al. Epidemiology of inflammatory bowel disease in Quebec: recent trends. Inflamm. Bowel Dis. 20, 1770–1776 (2014).

    Article  PubMed  Google Scholar 

  30. Leddin, D., Tamim, H. & Levy, A. R. Decreasing incidence of inflammatory bowel disease in Eastern Canada: a population database study. BMC Gastroenterol. 14, 140 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kaplan, G. G. Pitfalls and perils of using administrative databases to evaluate the incidence of inflammatory bowel disease overtime. Inflamm. Bowel Dis. 20, 1777–1779 (2014).

    Article  PubMed  Google Scholar 

  32. Bitton, A. et al. Decline in IBD incidence in Quebec: part of the changing epidemiologic pattern in North America. Inflamm. Bowel Dis. 20, 1782–1783 (2014).

    Article  PubMed  Google Scholar 

  33. Molodecky, N. A., Panaccione, R., Ghosh, S., Barkema, H. W. & Kaplan G. G. ; Alberta Inflammatory Bowel Disease Consortium. Challenges associated with identifying the environmental determinants of the inflammatory bowel diseases. Inflamm. Bowel Dis. 17, 1792–1799 (2011).

    Article  PubMed  Google Scholar 

  34. Hou, J. K., El-Serag, H. & Thirumurthi, S. Distribution and manifestations of inflammatory bowel disease in Asians, Hispanics, and African Americans: a systematic review. Am. J. Gastroenterol. 104, 2100–2109 (2009).

    Article  PubMed  Google Scholar 

  35. Probert, C. S. et al. Prevalence and family risk of ulcerative colitis and Crohn's disease: an epidemiological study among Europeans and south Asians in Leicestershire. Gut 34, 1547–1551 (1993).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Benchimol, E. et al. Inflammatory bowel disease in immigrants to Canada and their children: a population-based cohort study. Am. J. Gastroenterol. 110, 553–563 (2015).

    Article  PubMed  Google Scholar 

  37. Benchimol, E. et al. Asthma, type 1 and type 2 diabetes mellitus, and inflammatory bowel disease amongst South Asian immigrants to Canada and their children: A population-based cohort study. PLoS ONE 10, e0123599 (2015).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Zwi, A. B. & Mills, A. Health policy in less developed countries: past trends and future directions. J. Int. Dev. 7, 299–328 (1995).

    Article  CAS  PubMed  Google Scholar 

  39. Lai, C. L., Wu, P. C., Wong, K. L. & Lok, A. S. F. Clinical features of ulcerative proctocolitis in Hong Kong Chinese: a review of three decades. Am. J. Proctol Gastroenterol. Colon Rectal Surg. 36, 14–19 (1985).

    Google Scholar 

  40. Zheng, J. J. et al. Crohn's disease in mainland China: a systematic analysis of 50 years of research. Chin. J. Dig. Dis. 6, 175–181 (2005).

    Article  PubMed  Google Scholar 

  41. Chow, D. K. et al. Long-term follow-up of ulcerative colitis in the Chinese population. Am. J. Gastroenterol. 104, 647–654 (2009).

    Article  PubMed  Google Scholar 

  42. Frolkis, A. et al. Environment and the inflammatory bowel diseases. Can. J. Gastroenterol. 27, e18–e24 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Xavier, R. J. & Podolsky, D. K. Unravelling the pathogenesis of inflammatory bowel disease. Nature 448, 427–434 (2007).

    Article  CAS  PubMed  Google Scholar 

  44. Jostins, L. et al. Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature 491, 119–124 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Ananthakrishnan, A. N. Environmental risk factors for inflammatory bowel diseases: a review. Dig. Dis. Sci. 60, 290–298 (2015).

    Article  CAS  PubMed  Google Scholar 

  46. Knights, D., Lassen, K. G. & Xavier, R. J. Advances in inflammatory bowel disease pathogenesis: linking host genetics and the microbiome. Gut 62, 1505–1510 (2013).

    Article  CAS  PubMed  Google Scholar 

  47. Ng, S. C. et al. Genetics of inflammatory bowel disease in Asia: systematic review and meta-analysis. Inflamm. Bowel Dis. 18, 1164–1176 (2012).

    Article  PubMed  Google Scholar 

  48. Kaplan, G. G. IBD: Global variations in environmental risk factors for IBD. Nat. Rev. Gastroenterol. Hepatol. 11, 708–709 (2014).

    Article  PubMed  Google Scholar 

  49. Calkins, B. M. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig. Dis. Sci. 34, 1841–1854 (1989).

    Article  CAS  PubMed  Google Scholar 

  50. Cosnes, J., Beaugerie, L., Carbonnel, F. & Gendre, J. P. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology 120, 1093–1099 (2001).

    Article  CAS  PubMed  Google Scholar 

  51. Sands, B. E. et al. Risk of early surgery for Crohn's disease: implications for early treatment strategies. Am. J. Gastroenterol. 98, 2712–2718 (2003).

    Article  PubMed  Google Scholar 

  52. Coward, S. et al. Funding a smoking cessation program for Crohn's disease: an economic evaluation. Am. J. Gastroenterol. 110, 368–377 (2015).

    Article  PubMed  Google Scholar 

  53. Benjamin, J. L. et al. Smokers with active Crohn's disease have a clinically relevant dysbiosis of the gastrointestinal microbiota. Inflamm. Bowel Dis. 18, 1092–1100 (2012).

    Article  PubMed  Google Scholar 

  54. Health & Social Care Information Center. Statistics on Smoking: England, 2015. National Statistics [online]

  55. Giovino, G. A. et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet 380, 668–679 (2012).

    Article  PubMed  Google Scholar 

  56. Ng, S. C. et al. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut 64, 1063–1071 (2014).

    Article  PubMed  Google Scholar 

  57. Ananthakrishnan, A. N. Epidemiology and risk factors for IBD. Nat. Rev. Gastroenterol. Hepatol. 12, 205–217 (2015).

    Article  PubMed  Google Scholar 

  58. Ungaro, R. et al. Antibiotics associated with increased risk of new-onset Crohn's disease but not ulcerative colitis: a meta-analysis. Am. J. Gastroenterol. 109, 1728–1738 (2014).

    Article  CAS  PubMed  Google Scholar 

  59. Klement, E., Cohen, R. V., Boxman, J., Joseph, A., Reif, S. Breastfeeding and risk of inflammatory bowel disease: a systematic review with meta-analysis. Am. J. Clin. Nutr. 80, 1342–1352 (2004).

    Article  CAS  PubMed  Google Scholar 

  60. Soon, I. S. et al. The relationship between urban environment and the inflammatory bowel diseases: a systematic review and meta-analysis. BMC Gastroenterol. 12, 51 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  61. Ananthakrishnan, A. N. et al. A prospective study of long-term intake of dietary fiber and risk of Crohn's disease and ulcerative colitis. Gastroenterology 145, 970–977 (2013).

    Article  CAS  PubMed  Google Scholar 

  62. Pavlovic-Calic, N., Salkic, N. N., Gegic, A., Smajic, M. & Alibegovic, E. Crohn's disease in Tuzla region of Bosnia and Herzegovina: a 12-year study (1995–2006). Int. J. Colorectal Dis. 23, 957–964 (2008).

    Article  PubMed  Google Scholar 

  63. Quan, H. et al. International variation in the definition of 'main condition' in ICD-coded health data. Int. J. Qual. Health Care 26, 511–515 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Molodecky, N. A. & Kaplan, G. G. Environmental risk factors for inflammatory bowel disease. Gastroenterol. Hepatol. (N. Y.). 6, 339–346 (2010).

    Google Scholar 

  65. Hazlewood, G. S. et al. Comparative Effectiveness of immunosuppressants and biologics for inducing and maintaining remission in Crohn's disease: a network meta-analysis. Gastroenterology 148, 344–354 e345 (2015).

    Article  CAS  PubMed  Google Scholar 

  66. Feagan, B. G. et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N. Engl. J. Med. 369, 699–710 (2013).

    Article  CAS  PubMed  Google Scholar 

  67. Sandborn, W. J. et al. Ustekinumab induction and maintenance therapy in refractory Crohn's disease. N. Engl. J. Med. 367, 1519–1528 (2012).

    Article  CAS  PubMed  Google Scholar 

  68. Gerich, M. E. & McGovern, D. P. Towards personalized care in IBD. Nat. Rev. Gastroenterol. Hepatol. 11, 287–299 (2014).

    Article  CAS  PubMed  Google Scholar 

  69. Bewtra, M., Kaiser, L. M., TenHave, T. & Lewis, J. D. Crohn's disease and ulcerative colitis are associated with elevated standardized mortality ratios: a meta-analysis. Inflamm. Bowel Dis. Mar. 19, 599–613 (2013).

    Article  Google Scholar 

  70. Duricova, D. et al. Overall and cause-specific mortality in Crohn's disease: a meta-analysis of population-based studies. Inflamm Bowel Dis. 16, 347–353 (2010).

    Article  PubMed  Google Scholar 

  71. Singh, S. et al. Post-operative mortality among patients with inflammatory bowel diseases: a systematic review and meta-analysis of population-based studies. Gastroenterology http://dx.doi.org/10.1053/j.gastro.2015.06.001.

  72. Rezaie, R. et al. Time trends in prevalence and incidence of inflamhmatory bowel disease in Alberta: A population-based study. Can. J. Gastroenterol. 26, A133 (2012).

    Article  Google Scholar 

  73. Bernstein, C. N., Wajda, A. & Blanchard, J. F. The clustering of other chronic inflammatory diseases in inflammatory bowel disease: a population-based study. Gastroenterology 129, 827–836 (2005).

    Article  PubMed  Google Scholar 

  74. Bernstein, C. N., Wajda, A. & Blanchard, J. F. The incidence of arterial thromboembolic diseases in inflammatory bowel disease: a population-based study. Clin. Gastroenterol. Hepatol. 6, 41–45 (2008).

    Article  PubMed  Google Scholar 

  75. Bernstein, C. N., Blanchard, J. F., Leslie, W., Wajda, A. & Yu, B. N. The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study. Ann. Intern. Med. 133, 795–799 (2000).

    Article  CAS  PubMed  Google Scholar 

  76. Siegel, C. A., Marden, S. M., Persing, S. M., Larson, R. J. & Sands, B. E. Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn's disease: a meta-analysis. Clin. Gastroenterol. Hepatol. 7, 874–881 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Aljebreen, A. M. et al. Clinical epidemiology and phenotypic characteristics of Crohn's disease in the central region of Saudi Arabia. Saudi J. Gastroenterol. 20, 162–169 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  78. Zhao, J. et al. First prospective, population-based inflammatory bowel disease incidence study in mainland of China: the emergence of “Western” disease. Inflamm. Bowel Dis. 19, 1839–1845 (2013).

    PubMed  Google Scholar 

  79. Bodger, K., Kikuchi, T. & Hughes, D. Cost-effectiveness of biological therapy for Crohn's disease: Markov cohort analyses incorporating United Kingdom patient-level cost data. Aliment. Pharmacol. Therap. 30, 265–274 (2009).

    Article  CAS  Google Scholar 

  80. Lee, J. K., Tang, D. H., Mollon, L. & Armstrong, E. P. Cost-effectiveness of biological agents used in ulcerative colitis. Best Pract. Res. Clin. Gastroenterol. 27, 949–960 (2013).

    Article  PubMed  Google Scholar 

  81. Fiorino, G. & Danese, S. The biosimilar road in inflammatory bowel disease: the right way? Best Pract. Res. Clin. Gastroenterol. 28, 465–471 (2014).

    Article  PubMed  Google Scholar 

  82. Brodszky, V., Baji, P., Balogh, O. & Pentek, M. Budget impact analysis of biosimilar infliximab (CT-P13) for the treatment of rheumatoid arthritis in six Central and Eastern European countries. Eur. J. Health Econ. 15 (Suppl. 1) S65–S71 (2014).

    Article  PubMed  Google Scholar 

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Acknowledgements

G.G.K. is supported through a New Investigator Award from the Canadian Institute of Health Research and a Population Health Investigator Award from Alberta-Innovates Health-Solutions. F. Underwood, University of Calgary, is acknowledged for proofreading the article.

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  1. Departments of Medicine and Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, 6D56 Calgary, T2N 4Z6, AB, Canada

    Gilaad G. Kaplan

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G.G.K. has previously served as a speaker for Abbvie, Jansen, Merck, Schering-Plough and UCB Pharma, and has previously participated in advisory board meetings for Abbvie, Jansen, Merck, Schering-Plough, Shire and UCB Pharma. G.G.K. has also received research support from Abbvie, GlaxoSmithKline, Merck and Shire.

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Kaplan, G. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol 12, 720–727 (2015). https://doi.org/10.1038/nrgastro.2015.150

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