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Influence of Socioeconomic Development on Incidence and Disease Phenotype in Inflammatory Bowel Disease: A
Joyce W Y Mak1, Agnes H Y Ho1, Alicia K W Chan1
1State Key Laboratory of Digestive Disease, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Background & Aims:
The global rise in inflammatory bowel disease (IBD) parallels socioeconomic development, but its influence on disease epidemiology and phenotype remains unclear. We aimed to characterize IBD incidence, clinical features, and associations with socioeconomic indices across newly industrialized countries.
Methods:
This prospective population-based study spanned 16 regions in Africa, Asia, Latin America, and the Middle East from October 2021 for 1 year. Poisson regression estimated incidence rate ratios (IRRs) for Human Development Index (HDI), Sociodemographic Index, subnational HDI, and urban population percentage. Mixed-effects models examined associations with disease phenotype, activity, and treatment.
Results:
Of 606 incident cases (229 Crohn's disease [CD], 348 ulcerative colitis [UC], 29 IBD-unclassified), incidence varied widely. Hong Kong had the highest crude annual incidence (IBD, 7.43; CD, 2.69; UC, 3.44) and Vietnam the lowest (IBD, 0.13; CD, 0.04; UC, 0.08). Urban population (per 10% increase) was associated with a higher incidence of IBD (IRR, 1.68), CD (IRR, 1.73), and UC (IRR, 1.62). The HDI and Sociodemographic Index significantly correlated with CD (IRR, 4.05 and 2.96, respectively), but not subnational HDI. Higher HDI and subnational HDI were associated with increased odds of perianal CD (adjusted odds ratio, 2.61 and 2.40, respectively). Other disease phenotypes, activities, and treatment patterns were not significantly linked to any index.
Conclusions:
Higher urbanization and development are associated with higher IBD incidence, particularly CD, but not with disease activity at diagnosis. Notably, perianal CD was more common in regions with higher HDI and subnational HDI, suggesting an association with regional socioeconomic development. These highlight the need for region-specific early diagnosis strategies.
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