Inflammatory bowel disease burden in China and the United States from 1990-2023 and prediction to 2050

Inflammatory bowel disease (IBD) shows divergent epidemiological trends in China and the United States, necessitating country-specific forecasting approaches. This study compares IBD burden between both countries from 1990 to 2023 and projects future trends to 2050 using a multi-algorithm forecasting framework.

We analyzed data from the Global Burden of Disease Study 2023 (GBD 2023) for IBD incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression was used to characterize temporal trends, and the intrinsic estimator method was applied for age-period-cohort (APC) analysis. Future projections employed ten forecasting algorithms spanning traditional time series models, machine learning, and deep learning architectures, with optimal model selection for each country-measure combination based on cross-validation mean absolute percentage error (MAPE).

Between 1990 and 2023, China experienced a rise in age-standardized incidence from 0.75 to 1.41 per 100,000 (average annual percentage change [AAPC] = 1.93%) alongside declining mortality (AAPC =  - 2.55%). In contrast, the United States maintained relatively stable incidence (AAPC = 0.32%) but saw increasing death rates (AAPC = 1.71%). APC analysis revealed declining cohort effects in both countries, with steeper declines observed in China. The optimal forecasting model varied by country and measure: ElasticNet was most frequently selected for age-standardized rate projections, while Prophet and Holt's damped trend models performed best for absolute case number projections. By 2050, China's age-standardized incidence and prevalence rates are projected to increase (1.69 and 11.50 per 100,000, respectively), while death and DALY rates are projected to decline (0.22 and 4.12 per 100,000). For the United States, age-standardized rates are projected to remain relatively stable or decline modestly, while absolute case numbers are projected to increase substantially (prevalent cases: 1,208,253; deaths: 10,328), driven by population growth and aging.

China's IBD burden is characterized by rising incidence and prevalence alongside declining mortality, while the United States faces increasing absolute disease burden driven primarily by demographic change. The multi-algorithm forecasting approach, with country- and measure-specific model selection, accommodates the heterogeneous epidemiological patterns observed between these two countries.