Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific

Ng SC 1 , Kaplan GG 2 , Tang W 3 , Banerjee R 4 , Adigopula B 4 , Underwood FE 2 Show all authors , Tanyingoh D 2 , Wei SC 5 , Lin WC 6 , Lin HH 7 , Li J 8 , Bell S 9 , Niewiadomski O 9 , Kamm MA 9 , Zeng Z 10 , Chen M 10 , Hu P 10 , Ong D 11 , Ooi CJ 11 , Ling KL 12 , Miao Y 13 , Miao J 13 , Janaka de Silva H 14 , Niriella M 14 , Aniwan S 15 , Limsrivilai J 16 , Pisespongsa P 17 , Wu K 18 , Yang H 19 , Ng KK 20 , Yu HH 21 , Wang Y 22 , Ouyang Q 22 , Abdullah M 23 , Simadibrata M 23 , Gunawan J 23 , Hilmi I 24 , Lee Goh K 24 , Cao Q 25 , Sheng H 26 , Ong-Go A 27 , Chong VH 28 , Ching JYL 3 , Wu JCY 1 , Chan FKL 1 , Sung JJY 1

Affiliations 

  • 1 Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory Of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
  • 2 Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
  • 3 Department of Medicine and Therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China
  • 4 Asian Institute of Gastroenterology, Hyderabad, India
  • 5 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • 6 Mackay Memorial Hospital, Taipei, Taiwan
  • 7 Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
  • 8 Zhongnan Hospital, Wuhan University School of Medicine, Wuhan, China
  • 9 St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia
  • 10 The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
  • 11 National University Hospital of Singapore, Singapore, Singapore
  • 12 Singapore General Hospital, Singapore, Singapore
  • 13 The First Affiliated Hospital of Kunming Medical University, Yunnan, China
  • 14 Faculty of Medicine, University of Kelaniya, Regama, Sri Lanka
  • 15 King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 16 Siriraj Hospitial, Bangkok, Thailand
  • 17 Maharaj Nakorn Chiangmai Hospital, Chiangmai, Thailand
  • 18 Xijing Hospital, Fourth Military Medical University, Xian, China
  • 19 Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
  • 20 Hospital Conde S Januário, Macau, China
  • 21 Kiangwu Hospital, Macau, China
  • 22 West China Hospital, Sichuan University, Chengdu, China
  • 23 Faculty of Medicine Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • 24 University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 25 Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
  • 26 Xiangshan People's Hospital, Xiangshan, China
  • 27 Metropolitan Medical Center, Manila, Philippines
  • 28 Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam
Am J Gastroenterol, 2019 01;114(1):107-115.
PMID: 30177785 DOI: 10.1038/s41395-018-0233-2

Abstract

INTRODUCTION: Living in an urban environment may increase the risk of developing inflammatory bowel disease (IBD). It is unclear if this observation is seen globally. We conducted a population-based study to assess the relationship between urbanization and incidence of IBD in the Asia-Pacific region.

METHODS: Newly diagnosed IBD cases between 2011 and 2013 from 13 countries or regions in Asia-Pacific were included. Incidence was calculated with 95% confidence interval (CI) and pooled using random-effects model. Meta-regression analysis was used to assess incidence rates and their association with population density, latitude, and longitude.

RESULTS: We identified 1175 ulcerative colitis (UC), 656 Crohn's disease (CD), and 37 IBD undetermined (IBD-U). Mean annual IBD incidence per 100 000 was 1.50 (95% CI: 1.43-1.57). India (9.31; 95% CI: 8.38-10.31) and China (3.64; 95% CI, 2.97-4.42) had the highest IBD incidence in Asia. Incidence of overall IBD (incidence rate ratio [IRR]: 2.19; 95% CI: 1.01-4.76]) and CD (IRR: 3.28; 95% CI: 1.83-9.12) was higher across 19 areas of Asia with a higher population density. In China, incidence of IBD (IRR: 2.37; 95% CI: 1.10-5.16) and UC (IRR: 2.63; 95% CI: 1.2-5.8) was positively associated with gross domestic product. A south-to-north disease gradient (IRR: 0.94; 95% CI: 0.91-0.98) was observed for IBD incidence and a west-to-east gradient (IRR: 1.14; 95% CI: 1.05-1.24) was observed for CD incidence in China. This study received IRB approval.

CONCLUSIONS: Regions in Asia with a high population density had a higher CD and UC incidence. Coastal areas within China had higher IBD incidence. With increasing urbanization and a shift from rural areas to cities, disease incidence may continue to climb in Asia.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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