Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific

Siew C. Ng, Gilaad G. Kaplan, Whitney Tang, Rupa Banerjee, Bhargavi Adigopula, Fox E. Underwood, Divine Tanyingoh, Shu Chen Wei, Wei Chen Lin, Hung Hsin Lin, Jin Li, Sally Bell, Olga Niewiadomski, Michael A. Kamm, Zhirong Zeng, Minhu Chen, Pinjin Hu, David Ong, Choon Jin Ooi, Khoon Lin LingYinglei Miao, Jiarong Miao, H. Janaka De Silva, Madunil Niriella, Satimai Aniwan, Julajak Limsrivilai, Pises Pisespongsa, Kaichun Wu, Hong Yang, Ka Kei Ng, Hon Ho Yu, Yufang Wang, Qin Ouyang, Murdani Abdullah, Marcellus Simadibrata, Jeffri Gunawan, Ida Hilmi, Khean Lee Goh, Qian Cao, Hong Sheng, Arlinking Ong-Go, Vui Heng Chong, Jessica Y.L. Ching, Justin C.Y. Wu, Francis K.L. Chan, Joseph J.Y. Sung

Research output: Contribution to journalArticlepeer-review

111 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)107-115
Number of pages9
JournalAmerican Journal of Gastroenterology
Issue number1
Publication statusPublished - 1 Jan 2019


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