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Published on: September 22, 2019
Global Incidence, Prevalence, and Risk Factors of Microscopic Colitis, 1984-2020: A Systematic Review and
Hyun-June Yu1, Soeun Kim2, Jiyeon Oh1
1Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea; Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
Background & Aims:
Previous work on microscopic colitis (MC) has provided initial insights into its global epidemiology; however, an updated analysis remains necessary. We aimed to examine recent global trends in the incidence and prevalence of MC, stratified by subtype (collagenous colitis [CC] and lymphocytic colitis [LC]), age, sex, Human Development Index, and geographical region, and to update meta-analyses of key risk factors, including medication use and smoking.
Methods:
A systematic search was conducted in PubMed/MEDLINE, EMBASE, Google Scholar, Web of Science, and the Cochrane Library from their inception to June 23, 2025. MC was defined histologically via colonic biopsy. Only population-based observational studies were included. We additionally assessed potential risk factors and predictors of MC, including medication exposure and smoking. Pooled incidence and prevalence rates with 95% confidence intervals (CIs) were calculated using a random-effects model.
Results:
We included 42 studies (1984-2020) involving 75,363,808 participants and 91,148 MC cases from 10 countries in North America and Europe. The pooled global incidence rate per 100,000 person-years was 9.36 (95% CI, 7.63-11.48) for MC, 3.94 (95% CI, 3.08-5.05) for CC, and 4.49 (95% CI, 3.73-5.41) for LC. The pooled prevalence was 34.08 (95% CI, 19.20-60.47) per 100,000 persons for MC, 8.68 (95% CI, 3.96-19.01) for CC, and 12.50 (95% CI, 5.36-29.16) for LC. A temporal trend was observed in the incidence of MC and CC, with a significant rise from 2000 to 2012. Subgroup analyses showed associations between MC incidence and female, older age, regional predominance, medication exposure, and smoking. Notably, females were diagnosed with MC at an earlier age than males.
Conclusions:
This study offers updated global estimates of MC burden, noting recent regional trends. Observed heterogeneity and geographic variation highlight the need for further research into hormonal and environmental risk factors.
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