The Rising Burden of Inflammatory Bowel Disease in North America from 2015 to 2025: A Predictive Model

Abstract

Introduction: The prevalence of Inflammatory Bowel Disease (IBD) in North America has been increasing over the past century. The financial burden of IBD is substantial: for example, in 2004 the annual direct medical cost of IBD exceeded $6 billion in the US. We set out to model the evolution of prevalence and direct medical costs of Crohn's disease (CD) and ulcerative colitis (UC) in North America from 2015 to 2025. Methods: A systematic review identified population-based studies reporting on the prevalence of CD or UC after 1990 in Canada and the US. Data on prevalence was extracted and negative binomial models were created to predict the prevalence of CD and UC in Canada and the US from 2010 to 2030. Change in prevalence over time was reported as an annual percentage change (APC) with 95% confidence interval (CI). Extrapolated population data from Statistics Canada and the US Census Bureau were used to estimate the total number of individuals at risk for IBD in 2015 and 2025. The Consumer Price Indexes for each country were used to extrapolate direct medical costs for IBD in Canada and the US in 2015 and 2025, in their respective currencies. Results: In 2015 the prevalence of IBD is 0.52% and 1,870,181 are estimated to be living with IBD in North America (Table 1). Over the next decade the prevalence of IBD in North America will increase by 2.39% per year (95% CI: 1.39%, 3.41%) (Table 1). Between 2015 and 2025 the prevalence of CD will rise significantly in Canada (APC=3.75; 95% CI: 2.57, 4.93) and the US (APC=3.30; 95% CI: 0.17, 6.53); however, the prevalence will remain stable for UC (Table 1). By 2025 approximately 0.9% of Canadians and 0.6% of Americans will have IBD. In 2025 the number of individuals with IBD in North America is estimated to be 2,571,653 with direct healthcare costing over $27 billion (Table 1).Table 1: Change in prevalence of IBD between 2015 and 2025 in North AmericaConclusion: The prevalence of IBD will rise dramatically over the next decade such that 0.65% of individuals living in North America will have a diagnosis of IBD. The rise in prevalence will be dominated by Crohn's disease, whereas the prevalence of ulcerative colitis has plateaued in North America. In 2025 over 2.5 million individuals will have IBD and over $27 billion will be spent on direct healthcare costs. The substantial burden of IBD in North America in the next decade necessitates multifactorial solutions including innovating the delivery of healthcare and studying interventions that prevent the development of IBD.Figure 1