SHIFTS IN IBD INCIDENCE, MORTALITY, AND BURDEN: A COMPREHENSIVE ANALYSIS OF US AND GLOBAL TRENDS (1990-2019)
Authors: Maddineni Gautam , Choday Silpa , Morales Ambar , Aakash F N U , Kajal Diksha , Rehman Osama , Karpinska-Leydier Katarzyna , Salami Augustine , Begosh-Mayne Dustin , El-din Magdy , Brahambhatt Bhaumik 
Published: January 2024

Abstract

INTRODUCTION
Inflammatory Bowel Disease (IBD) represents a pervasive global health concern, affecting approximately 7 million individuals worldwide. To enhance the efficacy of disease management, it is imperative to comprehend the patterns in IBD incidence, mortality rates, and Disability-Adjusted Life Years (DALYs) in the United States(US) relative to global trends. This study utilizes data from the Global Burden of Disease Study(GBD) 2019 to comprehensively analyze IBD trends in the United States and worldwide from 1990 to 2019.

METHODS
Data on IBD incidence, deaths, and DALYs were extracted for the US and Globally from the GBD 2019. Statistical techniques and Bayesian geospatial regression analysis were employed to analyze the data. The study included stratification by location, sex, and year, and proportional models were used to assess the impact of IBD.

RESULTS
In 2019, the incidence of IBD in the United States was 85,387 cases, constituting 21% of the global incidence, an improvement from the 33% observed in 1990. The global incidence in 2019 had a favorable trend compared to 1990. IBD incidence in females exceeded that in males, a departure from the global pattern, where males exhibited a higher incidence. The US Age-Standardized Incidence Rate (ASIR) for IBD was 23.19 per 100,000 in 2019 (APC -1.3; 95% CI -1.4 to -1.2), 4.5 times higher than the global average.
Notably, the DALYs of IBD increased in both the US and globally between 1990 and 2019. However, the proportion of DALYs attributed to the US decreased from 15% to 13% of the global total. Furthermore, DALYs were more prevalent in females in the US and globally. The Age-Standardized DALYs(ASDALY) demonstrated a global decline, with the highest burden observed in US females at 54.63 per 100,000 (APC: 1.28; 95% CI 1.19-1.38).
The significant increase in IBD-related deaths globally is noteworthy, with the United States experiencing an almost 2.7-fold rise from 1990 to 2019, constituting 15% of the global total. Gender disparities in death rates mirrored those of incidence, with females exhibiting higher mortality rates in the US. In contrast, on a global scale, females experienced higher mortality rates despite lower incidence. The highest Age-Standardized Death Rate (ASDR) was observed among US females, registering at 1.08 (APC: 1.28; 95% CI 1.19 to 1.38).

CONCLUSION
This comprehensive analysis reveals notable shifts in IBD incidence, mortality, and DALYs between the United States and the global landscape. While the United States has made progress in reducing IBD incidence, it continues to face substantial challenges regarding DALYs and mortality, particularly among females. These findings underscore the need for targeted interventions and research to mitigate the burden of IBD in the United States and contribute to global disease management strategies.