Inflammatory Bowel Disease in Immigrants to Canada And Their Children: A Population-Based Cohort Study
Abstract
OBJECTIVES: The risk of inflammatory bowel disease (IBD) contributed by the environment can be elucidated by assessing the risk in migrants from low prevalence to Western countries. The incidence of IBD in immigrants to Canada and their Canadian-born children was compared with nonimmigrants. METHODS: A population-based cohort of IBD patients derived from health administrative data was linked to immigration data to determine the standardized incidence of IBD in immigrants to Ontario, Canada, by region of birth between 1994 and 2010. The hazard contributed by younger age at immigration was determined. Incidence for Ontario-born children of immigrant mothers was compared with the children of nonimmigrants. RESULTS: In 2,144,660 immigrants, incidence of IBD was 7.3/100,000 person-years compared with 23.9/100,000 in 12,036,921 nonimmigrants (incidence rate ratio (IRR) 0.34, 95% CI 0.26-0.44). Incidence was lowest risk in East Asians (IRR 0.14, 95% CI 0.11-0.18) and highest in Western Europeans/North Americans (IRR 0.59, 95% CI 0.46-0.75). Increased age at immigration was associated with decreased risk of IBD (HR 0.986, 95% CI 0.982-0.990), a 14% increased risk per younger decade of life at immigration. Children of immigrants from the Middle East/North Africa, South Asia, Sub-Saharan Africa, and North America/Western Europe had similar risk of IBD as children of nonimmigrants; however, the incidence remained lower among children of immigrants from other regions. CONCLUSIONS: Younger age at arrival to Canada increased the risk of IBD in immigrants. Canadian-born children of immigrants from some regions assumed the high Canadian incidence of IBD, indicating that the underlying risk is activated with earlier life exposure to the Canadian environment in certain groups.
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Migration from low-incidence regions into the Western world raises IBD prevalence because first-generation children of migrants have IBD risk similar to Western populations.
“Moreover, immigration from low-incidence countries/regions (for example, developing countries) to the Western world will lead to a further increase in prevalence as the first-generation offspring of immigrants have a similar risk of acquiring IBD as individuals in Western populations66.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [66]
Children of sub-Saharan African immigrants to Canada had IBD risk similar to children of non-immigrants.
“For example, children of immigrants from sub-Saharan Africa to Canada had a similar risk of IBD as children of non-immigrants66, and the same was observed among Ethiopian Jewish individuals immigrating to Israel81.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [66]
IBD can and does occur in people from developing countries.
“However, IBD can, and does, manifest among individuals from developing countries.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [66]
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- Authors
- Benchimol, E. I., Mack, D. R., Guttmann, A., Nguyen, G. C., To, T., Mojaverian, N., Quach, P., & Manuel, D. G.
- Affiliations
- University of Ottawa (CA)
- University of Toronto (CA)
- Mount Sinai Hospital (CA)
- Institute for Clinical Evaluative Sciences (CA)
- Children's Hospital of Eastern Ontario (CA)
- Corresponding author
- Benchimol, Eric I
- Venue
- American Journal of Gastroenterology
- Published
- 2015-04
- Volume
- 110
- Issue
- 4
- Pages
- 553-563
- ISSN
- 0002-9270 (ISSN-L)
- OpenAlex
- W1984153101
- Cited by
- 258
- References
- 22
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 24 · 2023: 24 · 2022: 26 · 2021: 27 · 2020: 19 · 2019: 29 · 2018: 18 · 2017: 35 · 2016: 21 · 2015: 8
- FWCI
- 18.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- inflammatory bowel disease, immigrants, immigrant children, IBD incidence, age at immigration, environmental risk factors, immigrant origin, East Asian immigrants
- MeSH terms
- Adolescent, Adult, Africa, Northern, Age Factors, Europe, Female, Humans, Male, Middle Aged, Middle East, North America, Ontario, Residence Characteristics, Retrospective Studies, Risk, Inflammatory Bowel Diseases, Cohort Studies, Incidence, Proportional Hazards Models, Africa South of the Sahara, Black People, White People, Asian People, Emigrants and Immigrants, Young Adult
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