DECIPHERING THE BURDEN OF INFLAMMATORY BOWEL DISEASE LANDSCAPE (1990-2019) IN HIGH INCOME NORTH AMERICA: PROJECTIONS, TEMPORAL SHIFTS, AND A GLIMPSE BEYOND TO 2040

Abstract

Abstract BACKGROUND In High-Income North America, IBD ranks as the 6th leading cause of disability and the 9th primary cause of mortality among all digestive diseases. The increasing prevalence in this region underscores the urgent need to address both the clinical and socio-economic challenges of managing this chronic condition in a developed setting. METHOD Utilizing Global Burden of DIsease tool, we estimated IBD prevalence, incidence, mortality, and Disability Adjusted Life Years (DALYs) of IBD in High-Income North America. Standardized statistical techniques facilitated comparisons by age, sex, year within this specific region. The DisMod-MR 2.1 tool was employed to estimate incidence and prevalence, while mortality rates were discerned using the Cause of Death Ensemble Model (CODEm). Additionally, we projected the deaths and Years of Life Lost (YLLs) up to 2040 using regression analysis. RESULTS From 1990 to 2019, the overall IBD prevalence in High-Income North America showed a decline from 1,100,006 (95%UI: 961,427-1,248,969) to 920,749 (859,032-982,587). However, deaths rose sharply from 2,442 (2,189-2,963) in 1990 to 6,313 (5,075-6,885) in 2019, marking an Annual Percentage Change (APC) surge of 159% (84-182). Meanwhile, DALYs grew by 17% (2-33). Age-Standardized Rates (ASR) indicate a reduction in incidence and DALYs rates by 30% and 22%, respectively, while mortality rates climbed by 42% (1-54). Country-specific trends show Canada and Greenland with incidence APC increases of 28% and 37%, respectively, while the U.S. saw a 12% decline. For mortality, the U.S. led with a 172% APC rise, followed by Greenland at 1,485% and Canada at 49%. In age-specific trends, children under five witnessed a 20% APC surge in incidence per 100,000 population, whereas the under-20 age bracket saw a 13% rise. Notably, those aged under 70 experienced an 89% jump in deaths from 1990-2019. CONCLUSION The marked shift in IBD prevalence and mortality in High-Income North America over three decades underscores the escalating challenge this disease presents to the healthcare landscape. The substantial increase in deaths, especially in countries like the U.S. and Greenland, combined with the age-specific trends, emphasizes the pressing need for targeted interventions and robust healthcare policies. Notably, in 2019, IBD was responsible for 4.43% of all deaths linked to digestive diseases and contributed to 6.13% of the total disabilities arising from digestive conditions. This data accentuates the profound and growing impact of IBD in the region and demands immediate, evidence-based action.