Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China.
Lancet. 2017 Dec 23;390(10114):2769-2778. doi: 10.1016/S0140-6736(17)32448-0. Epub 2017 Oct 16.
Inflammatory bowel disease is a global disease in the 21st century. We aimed to assess the changing incidence and prevalence of inflammatory bowel disease around the world.
We searched MEDLINE and Embase up to and including Dec 31, 2016, to identify observational, population-based studies reporting the incidence or prevalence of Crohn's disease or ulcerative colitis from 1990 or later. A study was regarded as population-based if it involved all residents within a specific area and the patients were representative of that area. To be included in the systematic review, ulcerative colitis and Crohn's disease needed to be reported separately. Studies that did not report original data and studies that reported only the incidence or prevalence of paediatric-onset inflammatory bowel disease (diagnosis at age <16 years) were excluded. We created choropleth maps for the incidence (119 studies) and prevalence (69 studies) of Crohn's disease and ulcerative colitis. We used temporal trend analyses to report changes as an annual percentage change (APC) with 95% CI.
We identified 147 studies that were eligible for final inclusion in the systematic review, including 119 studies of incidence and 69 studies of prevalence. The highest reported prevalence values were in Europe (ulcerative colitis 505 per 100 000 in Norway; Crohn's disease 322 per 100 000 in Germany) and North America (ulcerative colitis 286 per 100 000 in the USA; Crohn's disease 319 per 100 000 in Canada). The prevalence of inflammatory bowel disease exceeded 0·3% in North America, Oceania, and many countries in Europe. Overall, 16 (72·7%) of 22 studies on Crohn's disease and 15 (83·3%) of 18 studies on ulcerative colitis reported stable or decreasing incidence of inflammatory bowel disease in North America and Europe. Since 1990, incidence has been rising in newly industrialised countries in Africa, Asia, and South America, including Brazil (APC for Crohn's disease +11·1% [95% CI 4·8-17·8] and APC for ulcerative colitis +14·9% [10·4-19·6]) and Taiwan (APC for Crohn's disease +4·0% [1·0-7·1] and APC for ulcerative colitis +4·8% [1·8-8·0]).
At the turn of the 21st century, inflammatory bowel disease has become a global disease with accelerating incidence in newly industrialised countries whose societies have become more westernised. Although incidence is stabilising in western countries, burden remains high as prevalence surpasses 0·3%. These data highlight the need for research into prevention of inflammatory bowel disease and innovations in health-care systems to manage this complex and costly disease.
None.
炎症性肠病是 21 世纪的一种全球性疾病。我们旨在评估全球炎症性肠病的发病率和患病率的变化情况。
我们检索了 MEDLINE 和 Embase，截至 2016 年 12 月 31 日，以确定报告了 1990 年或之后克罗恩病或溃疡性结肠炎发病率或患病率的观察性、基于人群的研究。如果一项研究涉及特定区域的所有居民，并且患者能够代表该地区，则该研究被认为是基于人群的。为了纳入系统评价，溃疡性结肠炎和克罗恩病需要分别报告。未报告原始数据的研究以及仅报告儿童发病炎症性肠病（<16 岁诊断）发病率或患病率的研究被排除在外。我们创建了克罗恩病（119 项研究）和溃疡性结肠炎（69 项研究）发病率和患病率的专题地图。我们使用时间趋势分析报告了以每年百分比变化（APC）及其 95%置信区间（CI）表示的变化情况。
我们确定了 147 项最终纳入系统评价的研究，其中包括 119 项发病率研究和 69 项患病率研究。报告的最高患病率值出现在欧洲（挪威溃疡性结肠炎为 505/100000；德国克罗恩病为 322/100000）和北美（美国溃疡性结肠炎为 286/100000；加拿大克罗恩病为 319/100000）。北美、大洋洲和欧洲的许多国家，炎症性肠病的患病率超过 0.3%。总体而言，22 项克罗恩病研究中有 16 项（72.7%）和 18 项溃疡性结肠炎研究中有 15 项（83.3%）报告说，北美和欧洲的炎症性肠病发病率稳定或下降。自 1990 年以来，非洲、亚洲和南美洲的新兴工业化国家的发病率一直在上升，包括巴西（克罗恩病的发病率每年上升 11.1%[95%CI 4.8-17.8]，溃疡性结肠炎的发病率每年上升 14.9%[10.4-19.6]）和中国台湾（克罗恩病的发病率每年上升 4.0%[1.0-7.1]，溃疡性结肠炎的发病率每年上升 4.8%[1.8-8.0]）。
在 21 世纪之交，炎症性肠病已成为一种全球性疾病，在社会日益西化的新兴工业化国家，其发病率呈上升趋势。尽管西方国家的发病率趋于稳定，但由于患病率超过 0.3%，其疾病负担仍然很高。这些数据突出表明，需要研究炎症性肠病的预防措施，并创新医疗保健系统，以管理这种复杂和昂贵的疾病。
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