Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific
Journal
American Journal of Gastroenterology
Journal Volume
114
Journal Issue
1
Pages
107-115
Date Issued
2019
Author(s)
Ng S.C.
Kaplan G.G.
Tang W.
Banerjee R.
Adigopula B.
Underwood F.E.
Tanyingoh D.
Lin W.-C.
Lin H.-H.
Li J.
Bell S.
Niewiadomski O.
Kamm M.A.
Zeng Z.
Chen M.
Hu P.
Ong D.
Ooi C.J.
Ling K.-L.
Miao Y.
Miao J.
Janaka De Silva H.
Niriella M.
Aniwan S.
Limsrivilai J.
Pisespongsa P.
Wu K.
Yang H.
Ng K.K.
Yu H.H.
Wang Y.
Ouyang Q.
Abdullah M.
Simadibrata M.
Gunawan J.
Hilmi I.
Lee Goh K.
Cao Q.
Sheng H.
Ong-Go A.
Chong V.H.
Ching J.Y.L.
Wu J.C.Y.
Chan F.K.L.
Sung J.J.Y.
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. ©2018 by The American College of Gastroenterology.
Other Subjects
adult; Article; Australia; Brunei Darussalam; China; controlled study; Crohn disease; female; gross national product; Hong Kong; human; incidence; India; Indonesia; inflammatory bowel disease; inflammatory bowel disease undetermined; latitude; longitude; Macao; major clinical study; Malaysia; male; Philippines; population density; population research; priority journal; prospective study; risk factor; Singapore; Sri Lanka; Taiwan; Thailand; ulcerative colitis; urbanization; Asia; clinical trial; demography; health survey; inflammatory bowel disease; middle aged; multicenter study; Pacific islands; young adult; Adult; Asia; Australia; Demography; Female; Humans; Incidence; Inflammatory Bowel Diseases; Male; Middle Aged; Pacific Islands; Population Surveillance; Prospective Studies; Risk Factors; Young Adult
Publisher
Wolters Kluwer Health
Type
journal article