2Epidemiology of IBD during the twentieth century: an integrated view
Section snippets
Incidence studies
The incidence of a condition is defined as the number of new cases per year per 105 inhabitants in a given place. This incidence figure, compared over time in the same place and compared at a certain time in different places, was the first step in investigating the epidemiological characteristics of UC and CD.
Trends in the incidence of inflammatory bowel disease during the last half of the twentieth century
The first published epidemiological study of UC incidence was from the Oxford area of the UK and described the 10-year period between 1951 and 1960.4 It showed an increase from 4.7 to 9.7 new cases of UC per 105 inhabitants. Several studies have been published subsequently, of which those covering 15 years or more are shown in Figure 3. Two different patterns for incidence over time have been revealed:
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a steady increase5., 6., 7., 8. (Figure 3a)
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an increase followed by a plateau9., 10., 11., 12. (
Inflammatory bowel disease in children
Both UC and CD occur in childhood. From a population-based cohort from Copenhagen county21, it appears that 7% of the 1161 patients diagnosed with UC and 6% of 373 patients with CD had an onset before 15 years of age. The median age at diagnosis was 12 years (range 0–14 years), indicating a steep increase in incidence around puberty. During the 26 years of the study, no significant change in incidence was found; the mean incidence of IBD was 2.2 per 105.21 In another recent study of a large
Inflammatory bowel disease among other ethnic groups
Epidemiological studies on the incidence in UC23 and CD27 have been carried out in Leicestershire, UK—an area with a high proportion of immigrants from southern Asia. These studies have distinguished between native Europeans, Hindus, Sikhs and Muslims. No regular epidemiological studies from India, Pakistan and Bangladesh exist but the incidence of IBD has been suggested to be low.28 However, the diseases might be masked by amoebiasis, tuberculosis and other infections that are common in that
Prevalence of inflammatory bowel disease
The prevalence of IBD depends on the incidence, the survival and the age distribution of the population in question. It has been difficult to reveal meaningful figures for the true prevalence. However, in a recent British study30, two national birth cohorts (from 1958 and 1970) were followed and the prevalence was calculated for the population at age 30 years for both UC and CD. A significantly higher prevalence of CD was found in the population cohort born in 1970 than in the cohort born in
Survival
In their remarkable study31, Edwards and Truelove described the course and prognosis of UC based on 624 patients who were followed and treated in Oxford from 1938 to 1962. A fatality rate of 30% was revealed for patients referred for their first attack if it was initially classified as severe. Clinical severity and extent of disease was signifiantly correlated. The fatality rate was higher among patients above 60 years of age at diagnosis, whereas sex did not seem to influence the outcome.
In
Ulcerative proctitis
There has been a debate as to whether ulcerative proctitis and UC are two independent disease entities. Long-term epidemiological studies have revealed that proctitis often extends to more proximal and even to total colitis. In a recent study, Moum et al51 found that 22% of cases of proctitis progressed in extent within 12–24 months of initial diagnosis and despite medical treatment. Two long-term studies—Ayres et al52 and Langholz et al53—showed that 32 and 41% of initial proctitis cases,
Survival
Two early British studies, from Oxford and Birmingham, described an increased mortality in CD. Truelove and Pena54 pointed to a progressively more dangerous disease as time go by, unlike UC, which is most dangerous within the first few years. Prior et al55 found younger patients to be at a higher risk, and that the risk was highest within the first few years of diagnosis. These studies were not strictly population based. More recent long-term follow-up studies of population-based cohorts of
Summary
Current incidence figures were obtained from a multicenter study of 20 centres across Europe during 1991–93. The mean annual incidence of UC was 10.4/105 (95% CI: 7.6–13.1) and of CD 5.6/105 (95% CI: 2.8–8.3). The age and sex distribution and the localization of disease did not differ significantly between the centres. The incidence in the 8 centres north of the Alps was 40% higher for UC and 80% higher for CD than in the 12 southern centres. No north–south axis could be revealed.
The highest
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2020, The Lancet Gastroenterology and HepatologyCitation Excerpt :This pattern was preserved over time, suggesting that the burden of IBD was consistently greater in countries with a high index of development such as the UK, the USA, Canada, and Australia. This correlation, suggested by many studies,13–15 might indicate that there are common environmental pressures across these regions that act as important risk factors for IBD, although we did not evaluate the role of potential risk factors in IBD prevalence for this study. These risk factors might include urbanisation, more hygienic environments, and diets low in dietary fibre and high in meat.15,16