Ulcerative Colitis Resource Center

Ulcerative Colitis Resource Center

September 16, 2015
3 min read
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Expert highlights need to prepare for 'exponential' rise in IBD

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Clinicians and health care systems must prepare for the increasing global burden of inflammatory bowel disease, according to one expert, who pointed to an aging IBD population and an exponentially growing IBD prevalence expected over the next 10 years in the Western world.

In his recent article, Gilaad Kaplan, MD, MPH, FRCPC, associate professor, departments of medicine and community health sciences at University of Calgary in Canada, also raised concerns over rising prevalence in newly industrialized countries across every continent.

Gilaad Kaplan

“IBD is a modern disease of modern times,” Kaplan told Healio Gastroenterology. “We witnessed the rise of IBD in the Western world during the 20th century. At the turn of the 21st century, IBD has emerged in newly industrialized countries in every continent. In 2015, IBD is a global phenomenon.”

In addition to describing the current epidemiology of IBD, Kaplan’s article forecasts 2025 global prevalence using available epidemiological data, and proposes strategies to mitigate the future burden of IBD.

Compounding prevalence, aging population

“Over the next decade, the Western world will likely face an exponential rise in the prevalence of IBD,” Kaplan said. This projection considers the “compounding prevalence” of IBD in the West, or “the exponential rise in prevalence due to cumulative addition of incident cases in a chronic disease that has a young age of onset and low mortality.”

Illustrating this concept are prevalence trends from Alberta, Canada, which forecast an increase from 660 IBD cases per 100,000 in 2015 to 790 per 100,000 by 2025, corresponding to a nearly 70% increase in the absolute number of IBD patients, he wrote, adding that overall prevalence may be even higher due to the rising incidence of pediatric-onset IBD.

“Most health care systems are designed to manage natural population growth, but are not adequately prepared to manage compounding prevalence or an exponential rise in the number of patients with IBD over time,” he said. “Conceptually, this is seen in gastroenterology clinics that continue to add ‘new diagnoses’ of IBD, while continuing to follow their established cases. Every year, the proportion of patients with IBD in the clinic rises until eventually a tipping point is reached.”

Furthermore, Western gastroenterology clinics in 2025 will need to provide care for an aging population of IBD patients with “complex comorbidities,” including extraintestinal manifestations, IBD-related complications, and long-term effects of immunomodulators and biologics.

Newly industrialized countries

“In newly industrialized countries, the incidence of IBD is expected to continue to rise sharply,” Kaplan said. “With large population size and ongoing westernization, in 2025, countries like China and India may diagnose as many patients with IBD as seen in the United States.”

China, for example, would have more than 1.5 million IBD cases in 10 years if the prevalence plateaus at 0.1%, Kaplan wrote, though the extent of IBD growth in newly industrialized countries will depend on exposure to environmental risk factors, urbanization, health care access, adoption of medical technologies, natural population growth and advances in electronic surveillance and reporting of IBD, he added.

How to adapt

“Health care systems throughout the world will need to adapt to the changing landscape of IBD over the next decade or face a system that is overwhelmed by a flood of complex patients,” Kaplan said.

He proposes a “multifaceted approach” to mitigate the future global burden of IBD, which includes using forecasting models to predict regional utilization and allocation of health care resources, implementing innovative and efficient strategies to deliver care to a growing IBD population, and reducing reliance on biologics by adopting biosimilars and optimizing patient selection and dosing.

“Moreover, funding research that prioritizes the prevention of IBD is necessary to ultimately stem the global rise of IBD,” he said, particularly research on the interactions between genes, the environment and the intestinal microbiome. – by Adam Leitenberger

Disclosures: Kaplan reports he has previously served as a speaker for AbbVie, Janssen, Merck, Schering-Plough and UCB Pharma; has previously participated in advisory board meetings for AbbVie, Janssen, Merck, Schering-Plough, Shire and UCB Pharma; and has received research support from AbbVie, GlaxoSmithKline, Merck and Shire.