Global evolution of inflammatory bowel disease across epidemiologic stages

Hracs L. Windsor J.W. Gorospe J. Cummings M. Coward S. Buie M.J. Quan J. Goddard Q. Caplan L. Markovinović A. Williamson T. Abbey Y. Abdullah M. Abreu M.T. Ahuja V. Raja Ali R.A. Altuwaijri M. Balderramo D. Banerjee R. Benchimol E.I. Bernstein C.N. Brunet-Mas E. Burisch J. Chong V.H. Dotan I. Dutta U. El Ouali S. Forbes A. Forss A. Gearry R. Dao V.H. Hartono J.L. Hilmi I. Hodges P. Jones G.-R. Juliao-Baños F. Kaibullayeva J. Kelly P. Kobayashi T. Kotze P.G. Lakatos P.L. Lees C.W. Limsrivilai J. Lo B. Loftus E.V., Jr Ludvigsson J.F. Mak J.W.Y. Miao Y. Ng K.K. Okabayashi S. Olén O. Panaccione R. Paudel M.S. Quaresma A.B. Rubin D.T. Simadibrata M. Sun Y. Suzuki H. Toro M. Turner D. Iade B. Wei S.C. Yamamoto-Furusho J.K. Yang S.-K. Ng S.C. Kaplan G.G.
12 June 2025 Nature Research

Nature
2025 #642 Issue 8067 458 - 466 pp.

During the twentieth century, inflammatory bowel disease (IBD) was considered a disease of early industrialized regions in North America, Europe and Oceania¹. At the turn of the twenty-first century, IBD incidence increased in newly industrialized and emerging regions in Africa, Asia and Latin America, while the prevalence in early industrialized regions continued to grow steadily^{2, 3–4}. Changes in the incidence and prevalence denote the evolution of IBD across four epidemiologic stages: stage 1 (emergence), characterized by low incidence and prevalence; stage 2 (acceleration in incidence), marked by rapidly rising incidence and low prevalence; and stage 3 (compounding prevalence), where the incidence decelerates, plateaus or declines while the prevalence steadily increases. A fourth stage (prevalence equilibrium) has been proposed in which the prevalence slope plateaus due to demographic shifts in an ageing IBD population, but it has not yet been evidenced. To date, these stages have remained theoretical, lacking specific numerical indicators to define transition points. Here, using real-world data from 522 population-based studies encompassing 82 global regions and spanning more than a century (1920–2024), we show spatiotemporal transitions across stages 1–3 and model stage 4 progression. Understanding the evolution of IBD across epidemiologic stages enables healthcare systems to better anticipate the future worldwide burden of IBD.

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Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
Centre for Health Informatics and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
Maidstone and Tunbridge Wells NHS Trust, Kent, United Kingdom
Division of Gastroenterology, Department of Internal Medicine, HCRC IMERI, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
F. Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
Sir Jeffrey Cheah Sunway Medical School, Faculty of Medical and Life Sciences, Sunway University, Selangor, Malaysia
Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
IBD Unit, Gastroenterology Department, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
IBD Center, Asian Institute of Gastroenterology, Hyderabad, India
SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
ICES, Toronto, ON, Canada
Department of Medicine, and the University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
Gastroenterology Department, Parc Taulí Hospital Universitari, Institut d’Investigació I Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
Gastrounit, Medical Division, Copenhagen University Hospital—Amager and Hvidovre, Hvidovre, Denmark
Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital—Amager and Hvidovre, Hvidovre, Denmark
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Division of Gastroenterology and Hepatology, Department of Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan, Brunei Darussalam
Division of Gastroenterology, Rabin Medical Center, Petah-Tikva, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
Department of Medicine, University of Otago, Christchurch, New Zealand
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Internal Medicine Faculty, Hanoi Medical University, Hanoi, Viet Nam
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Division Gastroenterology & Hepatology, National University Hospital, Singapore, Singapore
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
University of Edinburgh, Institute for Regeneration and Repair, Edinburgh, United Kingdom
Department of Gastroenterology, Pablo Tobon Uribe Hospital, Medellín, Colombia
JSC Research Institute of Cardiology and Internal Diseases of the Ministry of Health of the Republic of Kazakhstan, Astana, Kazakhstan
Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
Health Sciences Postgraduate Program, Pontificia Universidade Católica do Paraná, Curitiba, Brazil
Division of Gastroenterology, McGill University, Montreal, QC, Canada
Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
Centre for Genomics and Experimental Medicine (CGEM), Institute of Genetics & Cancer, University of Edinburgh, Edinburgh, United Kingdom
Edinburgh IBD Unit, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
Division of Gastroenterology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
Department of Pediatrics, Örebro University Hospital, Stockholm, Sweden
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, China
Conde S. Januário Hospital, Macao
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
Department of Gastroenterology, National Academy of Medical Sciences, Kathmandu, Nepal
UNOESC Curso de Medicina: Universidade do Oeste de Santa Catarina, Joaçaba, Brazil
Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, United States
Division of Gastroenteroloy and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
Head of the Inflammatory Bowel Diseases Unit, HIGEA, Mendoza, Argentina
The Juliet Keidan Institute of Pediatric Gastroenterology & Nutrition, The Hebrew University of Jerusalem, Shaare Zedek Medical Center, Jerusalem, Israel
Cooperativa de Servicios Médicos (COSEM), Montevideo, Uruguay
Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
Inflammatory Bowel Disease Clinic, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition and National Autonomous University of Mexico (UNAM), Mexico City, Mexico
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
Microbiota I-Center (MagIC), Hong Kong
New Cornerstone Science Laboratory, The Chinese University of Hong Kong, Hong Kong

Division of Gastroenterology and Hepatology
Centre for Health Informatics and Department of Community Health Sciences
Maidstone and Tunbridge Wells NHS Trust
Division of Gastroenterology
F. Widjaja Inflammatory Bowel Disease Institute
International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Department of Gastroenterology
Sir Jeffrey Cheah Sunway Medical School
Division of Gastroenterology
IBD Unit
IBD Center
SickKids Inflammatory Bowel Disease Centre
Department of Paediatrics and Institute of Health Policy
Child Health Evaluative Sciences
ICES
Department of Medicine
Gastroenterology Department
CIBERehd
Departament de Medicina
Gastrounit
Copenhagen Center for Inflammatory Bowel Disease in Children
Department of Clinical Medicine
Division of Gastroenterology and Hepatology
Division of Gastroenterology
Department of Gastroenterology
Digestive Disease Institute
Digestive Disease and Surgery Institute
Department of Medicine
Department of Medical Epidemiology and Biostatistics
Internal Medicine Faculty
Yong Loo Lin School of Medicine
Division Gastroenterology & Hepatology
Division of Gastroenterology
Blizard Institute
Tropical Gastroenterology & Nutrition Group
University of Edinburgh
Department of Gastroenterology
JSC Research Institute of Cardiology and Internal Diseases of the Ministry of Health of the Republic of Kazakhstan
Asfendiyarov Kazakh National Medical University
Center for Advanced IBD Research and Treatment
Department of Gastroenterology
Health Sciences Postgraduate Program
Division of Gastroenterology
Department of Internal Medicine and Oncology
Centre for Genomics and Experimental Medicine (CGEM)
Edinburgh IBD Unit
Division of Gastroenterology
Division of Gastroenterology and Hepatology
Department of Pediatrics
Department of Medicine and Therapeutics
Gastroenterology
Yunnan Province Clinical Research Center for Digestive Diseases
Conde S. Januário Hospital
Department of Healthcare Epidemiology
Division of Clinical Epidemiology
Department of Gastroenterology
UNOESC Curso de Medicina: Universidade do Oeste de Santa Catarina
Health Sciences Postgraduate Program
Inflammatory Bowel Disease Center
Division of Gastroenteroloy and Hepatology
Head of the Inflammatory Bowel Diseases Unit
The Juliet Keidan Institute of Pediatric Gastroenterology & Nutrition
Cooperativa de Servicios Médicos (COSEM)
Department of Internal Medicine
Inflammatory Bowel Disease Clinic
Department of Gastroenterology
Department of Medicine and Therapeutics
Microbiota I-Center (MagIC)
New Cornerstone Science Laboratory

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