The changing epidemiology of IBD
The prevalence and incidence of inflammatory bowel disease (IBD) is increasing throughout the world1 and is emerging in populations previously at low risk.2 Shifts in disease prevalence are thought to stem from ongoing changes in diet, lifestyle, hygiene and exposure to environmental factors such as pollution.1,3 As industrialisation and globalisation increase within the developing world, the incidence of inflammatory bowel disease is expected to increase.3
While developing nations have only experienced a steep rise in IBD cases in recent years, IBD incidence has been a concern in Australia and New Zealand for decades.4 Since the 1980s, some of the highest incidence rates of IBD in the world have occurred in Australia and New Zealand.5 A 2010 study found the incidence of IBD was approximately 30 per 100,000 Australians per year, among the highest ever recorded.6 In developed nations the high prevalence of IBD is not entirely attributable to shifts in exposure to environmental factors. Advances in disease detection, physician awareness and longer duration of disease may have contributed to the observed rise in disease prevalence.1
As IBD is a condition often requiring lifelong therapy and monitoring, the increasing incidence worldwide is expected to become a considerable societal burden and impact both resource allocation and healthcare planning.6 To minimise the impact on the Australian healthcare system and the economy, primary healthcare providers must aim to deliver best practice and reduce the occurrence of potentially-avoidable morbidity and hospital admissions.7
1. Ponder A and Long MD. A clinical review of recent findings in the epidemiology of inflammatory bowel disease. Clin Epidemiol 2013; 5: 237–247.
2. Foster A and Jacobson K. Changing incidence of inflammatory bowel disease: environmental influences and lessons learnt from the South Asian population. Front Pediatr 2013; 1: 34.
3. Ng SC et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. Gastroenterology 2013; 145:158–165.
4. Lakatos PL. Recent trends in the epidemiology of inflammatory bowel diseases: up or down? World J Gastroenterol 2006; 12: 6102–6108.
5. Molodecky NA et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012; 142: 46–54.
6. Wilson J et al. High incidence of inflammatory bowel disease in Australia: a prospective population-based Australian incidence study. Inflamm Bowel Dis 2010; 1550–1556.
7. PricewaterhouseCoopers. Improving inflammatory bowel disease care across Australia. March 2013. Available from www. crohnsandcolitis.com.au/content/PwC_report_2013.pdf (accessed 13 January 2014).
AU-REM0196. Date prepared: April 2014.