Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific
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.
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Over the past 30 years, China experienced a massive population shift from rural communities to megacities each with more than ten million people.
“over the past 30 years, China experienced a massive population shift from rural communities to megacities, each with a population of more than ten million53.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [53]
The heterogeneity in incidence in newly industrialized countries is partly explained by the challenge of conducting high-quality population-based chronic disease surveillance due to regional population differences that make generalizing findings difficult.
“In part, the explanation for this heterogeneity is the challenge of conducting high-quality population-based chronic disease surveillance research in newly industrialized countries, due to the differences between regional populations (for example, the degree of westernization of diets and lifestyles) that make it difficult to generalize findings45,52,53.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [53]
In the ACCESS inception cohort (2011-2013), IBD incidence was 0.43 per 100,000 in the Philippines versus 2.98 per 100,000 in Hong Kong, and within mainland China varied from 0.54 per 100,000 in Xi'an to 3.64 per 100,000 in Guangzhou.
“the incidence of IBD (2011–2013) was a low 0.43 per 100,000 in the Philippines as compared with 2.98 per 100,000 in Hong Kong53. Furthermore, within nine separate regions in mainland China, the incidence varied from 0.54 per 100,000 in Xi’an to 3.64 per 100,000 in Guangzhou53.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [53]
Published incidence figures from some areas of Brazil, China and India are near the Western-world Coalescing Incidence Range, such as 6-11 per 100,000 for ulcerative colitis.
“For example, some regions in Brazil, China and India already have published incidence values that are close to the Coalescing Incidence Range (for example, 6–11 per 100,000 for ulcerative colitis) in the Western world4,49,53,57.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [53]
There is tremendous heterogeneity in reported IBD incidence rates among newly industrialized countries and among regions within them.
“Tremendous heterogeneity between the reported incidence rates exists among newly industrialized countries as well as among regions within these countries.”
From The four epidemiological stages in the global evolution of inflammatory bowel disease (2021) · cites this paper as [53]
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References 44 · Cited by 261
- Authors
- Ng, S. C., Kaplan, G. G., Tang, W., Banerjee, R., Adigopula, B., Underwood, F. E., Tanyingoh, D., Wei, S.-C., 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.
- Affiliations
- Chinese University of Hong Kong (HK)
- University of Calgary (CA)
- Asian Institute of Gastroenterology (IN)
- National Taiwan University Hospital (TW)
- Mackay Memorial Hospital (TW)
- Taipei Veterans General Hospital (TW)
- Wuhan University (CN)
- The University of Melbourne (AU)
- St Vincent's Hospital and University of Melbourne, Melbourne, VIC, Australia;
- The First Affiliated Hospital, Sun Yat-sen University (CN)
- National University Hospital (SG)
- Singapore General Hospital (SG)
- First Affiliated Hospital of Kunming Medical University (CN)
- Faculty of Medicine, University of Kelaniya, Regama, Sri Lanka;
- University of Kelaniya (LK)
- King Chulalongkorn Memorial Hospital (TH)
- Siriraj Hospital (TH)
- Maharaj Nakorn Chiang Mai Hospital (TH)
- Xijing Hospital (CN)
- Peking Union Medical College Hospital (CN)
- Hospital Conde S. Januário (CN)
- Kiang Wu Hospital (CN)
- Sichuan University (CN)
- University of Indonesia (ID)
- Faculty of Medicine Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia;
- University Malaya Medical Centre (MY)
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia;
- Sir Run Run Shaw Hospital (CN)
- Xiangyang Hospital of Traditional Chinese Medicine (CN)
- Metropolitan Medical Center, Manila, Philippines;
- Raja Isteri Pengiran Anak Saleha Hospital (BN)
- Corresponding author
- Ng, Siew C.
- Ng, Ka Kei
- ORCID
- Ng, Siew C.
- Kaplan, Gilaad G.
- Tang, Whitney
- Banerjee, Rupa
- Wei, Shu-Chen
- Lin, Hung-Hsin
- Bell, Sally
- Kamm, Michael A.
- Zeng, Zhirong
- Chen, Minhu
- Ong, David
- Ooi, Choon Jin
- Miao, Yinglei
- Miao, Jiarong
- Niriella, Madunil
- Aniwan, Satimai
- Limsrivilai, Julajak
- Pisespongsa, Pises
- Wu, Kaichun
- Yang, Hong
- Ng, Ka Kei
- Yu, Hon Ho
- Wang, Yufang
- Ouyang, Qin
- Abdullah, Murdani
- Gunawan, Jeffri
- Hilmi, Ida
- Cao, Qian
- Chong, Vui Heng
- Ching, Jessica Y. L.
- Wu, Justin C. Y.
- Chan, Francis K. L.
- Sung, Joseph J. Y.
- Venue
- American Journal of Gastroenterology
- Published
- 2019-01
- Volume
- 114
- Issue
- 1
- Pages
- 107-115
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- OpenAlex
- W2888987290
- Cited by
- 261
- References
- 44
- Citations by year
- 2026: 18 · 2025: 30 · 2024: 37 · 2023: 51 · 2022: 47 · 2021: 25 · 2020: 34 · 2019: 19
- FWCI
- 11.96
- 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 › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Keywords
- inflammatory bowel disease, Crohn's disease, ulcerative colitis, IBD incidence, population density, urbanization, urban-rural gradient, gross domestic product, Asia-Pacific region, China, India, geographic coordinates, coastal areas, environmental risk factors, socioeconomic factors, gut microbiota, lifestyle, hygiene hypothesis, intestinal permeability
- MeSH terms
- Adult, Asia, Australia, Demography, Female, Humans, Male, Middle Aged, Pacific Islands, Population Surveillance, Prospective Studies, Risk Factors, Inflammatory Bowel Diseases, Incidence, Young Adult
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