Incidence Trends of Inflammatory Bowel Disease in a Southern European Country: A Mirror of the Western World?

Abstract

INTRODUCTION:Inflammatory bowel disease (IBD) affects people from all age categories worldwide. Although the incidence of the disease is stabilizing or decreasing in most Western world countries, its prevalence is still increasing because of the rise in life expectancy and better disease management. This work intends to identify the trends related to IBD incidence nationwide, analyzing regional, sex, and age distributions.METHODS:Data were provided by the Portuguese Shared Services of the Ministry of Health. This study consisted of a retrospective analysis of all first consultations coded for “Chronic enteritis/ulcerative colitis” (D94) in a primary healthcare setting, between 2017 and 2020, in Portugal. The primary outcome measure was the IBD incidence rate per 100,000 inhabitants. We also calculated the incidence rate per person-year and forecasted incidence until 2024.RESULTS:Between 2017 and 2019, the incidence rate of IBD in Portugal decreased from 54.9 to 48.6 per 100,000 inhabitants. The average incidence was 20 new cases of IBD per 1,000 person-year. It was predicted that, in December 2023, IBD incidence would reach 305.4 new cases (95% Prediction Interval 156.6–454.3), a similar result to the values forecasted for December 2021 (305.4, 95% Prediction Interval 197.3–413.6).DISCUSSION:The incidence of IBD slightly declined from 2017 to 2019, and it is posed to stabilize in the future. The presented data are of the utmost importance for the characterization of IBD in Southern European countries and the establishment of future health policies in the setting of compounding prevalence in the Western world.

Crossing barriers: the burden of inflammatory bowel disease across Western Europe

“…The latest epidemiological data for Belgium dates to the 1990s, documenting incidence rates of 4.1/100,000 for CD and 3.7/100,000 for UC patients. 25 , 26 In Portugal, Santiago et al 14 reported a high IBD incidence rate of 48.6/100,000 person-years. This study’s methodology, however, could not guarantee that all cases investigated had a confirmed diagnoses of IBD and thus may have included false-positive results.…”

“…10,11 Although Southern European countries have often been considered as low prevalent areas for IBD, recent studies have proven this is no longer the case, as can be seen from recent studies from Spain, Italy and Portugal. [12][13][14][15][16][17] Western Europe is vast and disease rates vary not only between countries, but within each country itself. One of the largest UK studies to determine epidemiology rates in IBD explored health records from more than 38.3 million people between 2000 and 2020 and found a population incidence rate of 36 new cases per 100,000 person-years, with greater rates in Scotland and Northern Ireland compared to England and Wales.…”

“…The cause for this remains unclear due to the lack of published data although it is postulated that the main contributing factors are the rising disease prevalence, delayed diagnoses of CD leading to more complex and complicated disease and the European guidelines recommending elective surgery when possible and early surgical interventions for the more complicated cases. 14,45,46 A global systematic review from 42 countries with temporal trend analysis from 35 countries has demonstrated stable hospitalisation rates for both UC and CD in countries with rising prevalence rates. 47 This comprises of countries in the Western world, including most countries in North America, Western Europe and Oceania.…”

“… 10 , 11 Although Southern European countries have often been considered as low prevalent areas for IBD, recent studies have proven this is no longer the case, as can be seen from recent studies from Spain, Italy and Portugal. 12 – 17 …”

“…The cause for this remains unclear due to the lack of published data although it is postulated that the main contributing factors are the rising disease prevalence, delayed diagnoses of CD leading to more complex and complicated disease and the European guidelines recommending elective surgery when possible and early surgical interventions for the more complicated cases. 14 , 45 , 46 …”