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 Ling; Yinglei 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

doi:10.1038/s41395-018-0233-2

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

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

111 Citations (Scopus)

Abstract

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 language	English
Pages (from-to)	107-115
Number of pages	9
Journal	American Journal of Gastroenterology
Volume	114
Issue number	1
DOIs	https://doi.org/10.1038/s41395-018-0233-2
Publication status	Published - 1 Jan 2019

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Ng, S. C., Kaplan, G. G., Tang, W., Banerjee, R., Adigopula, B., Underwood, F. E., Tanyingoh, D., Wei, S. C., Lin, W. C., Lin, H. H., Li, J., Bell, S., Niewiadomski, O., Kamm, M. A., Zeng, Z., Chen, M., Hu, P., Ong, D., Ooi, C. J., ... Sung, J. J. Y. (2019). Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific. American Journal of Gastroenterology, 114(1), 107-115. https://doi.org/10.1038/s41395-018-0233-2

@article{002eaeea994b4c7d94ed0edc44abb386,

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

abstract = "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.",

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

note = "Publisher Copyright: {\textcopyright}2018 by The American College of Gastroenterology.",

year = "2019",

month = jan,

day = "1",

doi = "10.1038/s41395-018-0233-2",

language = "English",

volume = "114",

pages = "107--115",

journal = "American Journal of Gastroenterology",

issn = "0002-9270",

publisher = "Springer Nature",

number = "1",

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Ng, SC, Kaplan, GG, Tang, W, Banerjee, R, Adigopula, B, Underwood, FE, Tanyingoh, D, Wei, SC, Lin, WC, Lin, HH, Li, J, Bell, S, Niewiadomski, O, Kamm, MA, Zeng, Z, Chen, M, Hu, P, Ong, D, Ooi, CJ, Ling, KL, Miao, Y, Miao, J, Janaka De Silva, H, Niriella, M, Aniwan, S, Limsrivilai, J, Pisespongsa, P, Wu, K, Yang, H, Ng, KK, Yu, HH, Wang, Y, Ouyang, Q, Abdullah, M , Simadibrata, M, Gunawan, J, Hilmi, I, Lee Goh, K, Cao, Q, Sheng, H, Ong-Go, A, Chong, VH, Ching, JYL, Wu, JCY, Chan, FKL & Sung, JJY 2019, 'Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific', American Journal of Gastroenterology, vol. 114, no. 1, pp. 107-115. https://doi.org/10.1038/s41395-018-0233-2

TY - JOUR

T1 - Population Density and Risk of Inflammatory Bowel Disease

T2 - A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific

AU - Ng, Siew C.

AU - Kaplan, Gilaad G.

AU - Tang, Whitney

AU - Banerjee, Rupa

AU - Adigopula, Bhargavi

AU - Underwood, Fox E.

AU - Tanyingoh, Divine

AU - Wei, Shu Chen

AU - Lin, Wei Chen

AU - Lin, Hung Hsin

AU - Li, Jin

AU - Bell, Sally

AU - Niewiadomski, Olga

AU - Kamm, Michael A.

AU - Zeng, Zhirong

AU - Chen, Minhu

AU - Hu, Pinjin

AU - Ong, David

AU - Ooi, Choon Jin

AU - Ling, Khoon Lin

AU - Miao, Yinglei

AU - Miao, Jiarong

AU - Janaka De Silva, H.

AU - Niriella, Madunil

AU - Aniwan, Satimai

AU - Limsrivilai, Julajak

AU - Pisespongsa, Pises

AU - Wu, Kaichun

AU - Yang, Hong

AU - Ng, Ka Kei

AU - Yu, Hon Ho

AU - Wang, Yufang

AU - Ouyang, Qin

AU - Abdullah, Murdani

AU - Simadibrata, Marcellus

AU - Gunawan, Jeffri

AU - Hilmi, Ida

AU - Lee Goh, Khean

AU - Cao, Qian

AU - Sheng, Hong

AU - Ong-Go, Arlinking

AU - Chong, Vui Heng

AU - Ching, Jessica Y.L.

AU - Wu, Justin C.Y.

AU - Chan, Francis K.L.

AU - Sung, Joseph J.Y.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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U2 - 10.1038/s41395-018-0233-2

DO - 10.1038/s41395-018-0233-2

M3 - Article

C2 - 30177785

AN - SCOPUS:85053307043

SN - 0002-9270

VL - 114

SP - 107

EP - 115

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

IS - 1

ER -

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

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