IBD: Global Trends
Incidence
As shown in Table 1, the global incident cases of IBD were 375140 (95%UI, 327686–436925) in 2021. From 1990 to 2021, there was an 88.30% increase in global incident cases of IBD, the EAPC was 0.91 (95%CI, 0.81–1.02). The corresponding age-standardised incident rate (ASIR) increased accordingly 4.22 (95%UI, 3.72–4.88) in 1990 to 4.45 (95%UI, 3.87–5.19) in 2021; Over this period, there was a rise in the number of IBD cases across all age groups, with the most significant increase seen in patients aged 50 to 54 years and the smallest increase among patients aged < 5 years. In 1990, the greatest number of patients were in the 35–39 years age group, while in 2021, the greatest number of patients were in the 40–44 years age group (22902 and 39708 patients, respectively). In 2021, the ASIR of IBD was greater in males than in females [4.52 (95%UI, 3.93–5.28) vs 4.38 (95%UI, 3.82–5.11)]. There was no significant difference in the incidence rate of IBD between males and females at any age in 2021 (Fig. 1a).
Table 1
Incident cases and age-standandised rate of Inflammatory bowel disease Between 1990 and 2021 at the Global and Regional Level
Location | All-age cases (95% UI) | Age-standandised incidence rates (95% UI) | EAPCs |
1990 | 2021 | 1990 | 2021 |
Global | 199236(174584–232676) | 375140(327686–436925) | 4.22(3.72–4.88) | 4.45(3.87–5.19) | 0.29(0.20–0.38) |
Andean Latin America | 399(342–483) | 1050(896–1298) | 1.36(1.17–1.65) | 1.59(1.37–1.96) | 0.56(0.49–0.63) |
Australasia | 4002(3422–4743) | 7307(6372–8465) | 18.09(15.48–21.37) | 19.66(17.07–23.20) | 0.48(0.30–0.66) |
Caribbean | 727(617–881) | 1379(1182–1660) | 2.27(1.94–2.74) | 2.71(2.32–3.27) | 0.55(0.49–0.62) |
Central Asia | 2524(2178–3067) | 5018(4317–6101) | 4.40(3.79–5.32) | 5.16(4.47–6.22) | 0.50(0.47–0.53) |
Central Europe | 7318(6410–8624) | 9297(8128–10754) | 5.37(4.68–6.35) | 6.48(5.61–7.73) | 0.79(0.60–0.98) |
Central Latin America | 739(626–904) | 1502(1263–1849) | 0.58(0.50–0.70) | 0.57(0.48–0.69) | 0.15(0.02–0.27) |
Central Sub-Saharan Africa | 505(433–616) | 1751(1488–2156) | 1.37(1.19–1.64) | 1.83(1.59–2.22) | 1.02(0.99–1.04) |
East Asia | 8633(7284–10588) | 25532(22107–30530) | 0.74(0.64–0.90) | 1.39(1.20–1.66) | 2.89(2.35–3.43) |
Eastern Europe | 8896(7706–10721) | 11229(9681–13550) | 3.43(2.98–4.14) | 4.10(3.56–4.95) | 0.57(0.53–0.62) |
Eastern Sub-Saharan Africa | 1642(1407–2000) | 4903(4178–5999) | 1.36(1.18–1.62) | 1.68(1.45–1.99) | 0.80(0.74–0.86) |
High-income Asia Pacific | 4179(3633–4948) | 6531(5695–7659) | 2.15(1.87–2.56) | 2.78(2.41–3.33) | 1.10(0.61–1.60) |
High-income North America | 52440(46626–59946) | 84757(75246–95386) | 16.76(14.89–19.19) | 18.51(16.34–21.17) | 0.37(0.26–0.48) |
North Africa and Middle East | 7180(6129–8700) | 19656(16586–24187) | 2.73(2.35–3.27) | 3.18(2.73–3.87) | 0.56(0.51–0.60) |
Oceania | 33(28–41) | 90(76–112) | 0.65(0.56–0.79) | 0.76(0.65–0.93) | 0.46(0.41–0.50) |
South Asia | 40231(34456–48840) | 106215(91605–128247) | 4.98(4.32–5.97) | 6.00(5.21–7.23) | 0.66(0.58–0.74) |
Southeast Asia | 2268(1922–2798) | 5035(4271–6181) | 0.57(0.49–0.70) | 0.68(0.58–0.83) | 0.51(0.47–0.55) |
Southern Latin America | 2152(1853–2632) | 3615(3128–4385) | 4.50(3.87–5.51) | 4.75(4.10–5.81) | 0.19(0.13–0.24) |
Southern Sub-Saharan Africa | 630(539–762) | 1285(1101–1551) | 1.64(1.42–1.96) | 1.72(1.49–2.04) | 0.26(0.17–0.36) |
Tropical Latin America | 2362(2030–2878) | 7616(6550–9287) | 1.87(1.62–2.26) | 2.95(2.54–3.59) | 1.03(0.53–1.53) |
Western Europe | 50598(45346–57683) | 66438(58285–76430) | 11.66(10.42–13.35) | 12.74(11.08–15.02) | 0.32(0.16–0.48) |
Western Sub-Saharan Africa | 1778(1527–2150) | 4933(4236–5971) | 1.37(1.19–1.64) | 1.49(1.30–1.77) | 0.11(-0.01-0.22) |
World Bank Lower Middle Income | 51880(44592–62807) | 132894(114380–160720) | 3.49(3.04–4.18) | 4.15(3.60–4.98) | 0.62(0.56–0.68) |
World Bank Upper Middle Income | 25765(22169–31370) | 56908(49335–68255) | 1.41(1.23–1.70) | 1.87(1.62–2.25) | 1.25(1.02–1.48) |
World Bank High Income | 118331(105573–136104) | 176058(155563–200745) | 10.33(9.18–11.91) | 11.49(10.04–13.31) | 0.41(0.27–0.57) |
World Bank Low Income | 3065(2605–3728) | 9004(7636–11042) | 1.43(1.24–1.72) | 1.78(1.54–2.14) | 0.75(0.72–0.78) |
Mortality
In the last thirty years, there has been a 98.07% increase in global deaths associated with IBD, with 21,418 deaths documented in 1990 as opposed to 42,422 deaths in 2021. However, the age-standardised mortality rate (ASMR) associated with IBD dropped from 0.60 (0.52–0.66) per 100,000 in 1990 to 0.52 (0.46–0.58) per 100,000 in 2021, with an EAPC of -0.31 (95%CI, − 0.49 to − 0.13) (Supplement Table 1). From 1990 to 2021, while the number of IBD-related deaths decreased among children aged 0 to 14 years, there was an increase in deaths among patients in all other age groups. The most significant increase in the number of IBD-associated deaths was observed in patients aged 85–89 years. The highest number of deaths occurred in patients aged 75–79 years in 1990 and 85–89 years in 2021 (2780 and 6045, respectively). In 2021, the mortality rate among IBD patients under 75 years of age was similar between males and females, while among those aged over 75 years, the rate was greater in females than in males (Fig. 1b).
DALYs
The global number of DALYs associated with IBD exhibited a 59.22% increase from 1990 to 2021, rising from 948861 (95%UI, 808101–1096717) in 1990 to 1510784 (95%UI, 1308508–1750363) in 2021. However, the rate of IBD-associated age-standardised DALYs per 100,000 population decreased from 21.55 (95%UI, 18.47–24.82) in 1990 to 18.07 (95%UI, 15.67–20.91) in 2021; the EAPC was − 0.52 (95%CI, − 0.61 to − 0.43) (Supplement Table 2). Over the same period, the number of IBD-associated DALYs increased across all age groups, except for a decrease observed among children under 14 years. Notably, the most significant increase numbers in IBD-associated DALYs occurred among patients aged 70–74 years. The groups with the highest numbers of DALYs associated with IBD in 1990 and 2021 were patients aged 40–44 years (75,857) and patients aged 60–64 years (130,766), respectively. In 2021, the rate of IBD-associated DALYs among male and female patients under 80 years of age was similar, while among female patients over 80 years of age, the rate was greater than that among male patients (Fig. 1c).
IBD: World Bank income Trends
Incidence
The World Bank high-income region exhibited the highest number of cases of IBD patients in 2021 (176058; 95%UI, 155563–200745). From 1990 to 2021, the incident cases in the World Bank low-income region saw a significant increase of 193.77%, the most substantial rise in the ASIR of IBD occurred in the World Bank upper-middle income region (EAPC,1.25; 95%CI, 1.02–1.48) (Table 1 and Supplement Fig. 1).
Mortality
In 2021, the World Bank high-income region recorded the highest number (21580; 95%UI, 18333–23241) and ASMR (0.80; 95%UI, 0.69–0.85) of IBD-associated deaths, while the lowest ASMR were observed in the World Bank upper-middle income region (0.34; 95%UI, 0.29–0.41). Among the 4 regions, the World Bank high-income region also experienced the most significant increase of ASMR from 1990 to 2021 (EAPC,1.00; 95%CI, 0.67–1.34), while the World Bank upper-middle income region had the lowest EAPC in the IBD-associated ASMR (-1.98; 95%UI, − 2.12 to -1.83) (Supplement Table 1 and Supplement Fig. 2).
DALYs
Among the 4 regions, the World Bank upper-middle Income region (EAPC,-1.88; 95%CI, -1.95–1.80) and World Bank lower-middle Income region (EAPC,-0.54; 95%CI, -0.58–0.50) both experienced a decrease in age-standardised DALYs associated with IBD from 1990 to 2021. In 2021, the World Bank high-income region had the highest number of IBD associated DALYs (664515; 95%UI, 556669–787996) showing a dramatic increase of 72.69% from 1990 to 2021 (Supplement Table 2 and Supplement Fig. 3).
IBD Geographic Regional Trends
Incidence
Among 21 geographic regions, South Asia had the most incidence cases of IBD in 2021 (106215; 95%UI, 91605–128247]), whereas Oceania had the fewest (90; 95%UI, 76–112). In 2021, the ASIR of IBD was highest in Australasia (19.67; 95%UI, 17.07–23.20). In contrast, the ASIR of IBD was lowest in Central Latin America (0.57; 95%UI, 0.48–0.70). From 1990 to 2021, East Asia experienced the largest increase in the ASIR of IBD (EAPC, 2.89; 95%CI, 2.35–3.43), whereas the Western Sub-Saharan Africa had the smallest increase (EAPC, 0.11; 95%CI, -0.01-0.22) (Table 1, Fig. 2a and 2d).
Mortality
In the year 2021, Western Europe reported the highest incidence of deaths associated with IBD, with a total of 12,791 fatalities (95%UI, 10,650 − 13,952). Additionally, Western Europe exhibited the highest ASMR for IBD at 1.11 (95%UI, 0.95–1.20). Australasia had the highest increase in the IBD-associated ASMR (EAPC, 3.54; 95%CI, 2.58 to 4.50), whereas High-income Asia Pacific had the largest decrease (EAPC, − 3.42; 95%CI, − 3.78 to − 3.05) (Supplement Table 1 and Fig. 2b and 2e).
DALYs
In 2021, Western Europe exhibited the highest number of IBD-associated DALYs (318237; 95%UI, 270223–372594), whereas Oceania reported the lowest number (884; 95%UI, 631–1235). High-income North America had the highest age-standardised DALYs rate (49.59; 95%UI, 40.23–60.57); Southeast Asia had the age-standardised lowest DALYs rate (6.14; 95%UI, 4.63–7.23). Over the period from 1990 to 2021, Australasia experienced the largest increase in the age-standardised DALYs rate (EAPC, 1.08; 95%CI, 0.74 to 1.43); East Asia had the largest decrease (EAPC, − 2.89; 95%CI, − 3.18 to − 2.61) (Supplement Table 2 and Fig. 2c and 2f).
IBD: National Trends
Incidence
In 2021, Canada exhibited the highest ASIR of IBD among 204 countries (26.83; 95%UI, 23.30-30.76), whereas Mexico had the lowest incidence (0.20; 95%UI, 0.17–0.25) (Fig. 2a). Besides, India had the most cases of IBD in 2021 (84479; 95%UI, 102208 − 72940). China had the greatest increases in the ASIR from 1990 to 2021 (EAPC, 2.93; 95%CI, 2.38–3.49) (Fig. 2d).
Mortality
United States of America had the highest number of IBD-associated deaths in(6193; 95%UI, 5405–6618). Netherlands (2.21; 95%CI, 1.85–2.43) had the highest IBD-associated ASMR (Fig. 2b); Singapore (0.03;95%CI, 0.02–0.03) had the lowest mortality rate. Germany (EAPC, 4.12; 95%CI, 3.49–4.75) exhibited the greatest increases in the ASMR (Fig. 2e); Estonia (EAPC, − 6.75; 95%CI, − 8.43 to − 5.04) had the greatest decreases.
DALYs
In 2021, United States of America had the highest number of IBD-associated DALYs [(235017; 95%UI, 197312–279176)]. Netherlands had the highest age-standardised rate of IBD-associated DALYs (74.96; 95%UI, 60.11–91.48) (Fig. 2c). Libya (EAPC, 1.79; 95%CI, 1.54–2.04) reported the greatest increase in age-standardised DALYs rate (Fig. 2f); the American Aamoa (EAPC,−5.27; 95%CI, − 5.72 to − 4.82) had the greatest decreases.