Global evolution of inflammatory bowel disease across epidemiologic stages

Lindsay Hracs, Joseph W. Windsor, Julia Gorospe, Michael Cummings, Stephanie Coward, Michael J. Buie, Joshua Quan, Quinn Goddard, Léa Caplan, Ante Markovinović, Tyler Williamson, Yvonne Abbey, Murdani Abdullah, Maria T. Abreu, Vineet Ahuja, Raja Affendi Raja Ali, Mansour Altuwaijri, Domingo Balderramo, Rupa Banerjee, Eric I. Benchimol, Charles N. Bernstein, Eduard Brunet-Mas, Johan Burisch, Vui Heng Chong, Iris Dotan, Usha Dutta, Sara El Ouali, Angela Forbes, Anders Forss, Richard Gearry, Viet Hang Dao, Juanda Leo Hartono, Ida Hilmi, Phoebe Hodges, Gareth-Rhys Jones, Fabián Juliao-Baños, Jamilya Kaibullayeva, Paul Kelly, Taku Kobayashi, Paulo Gustavo Kotze, Peter L. Lakatos, Charlie W. Lees, Julajak Limsrivilai, Bobby Lo, Edward V. Loftus, Jonas F. Ludvigsson, Joyce W. Y. Mak, YingLei Miao, Ka Kei Ng, Shinji Okabayashi, Ola Olén, Remo Panaccione, Mukesh Sharma Paudel, Abel Botelho Quaresma, David T. Rubin, Marcellus Simadibrata, Yang Sun, Hidekazu Suzuki, Martin Toro, Dan Turner, Beatriz Iade, Shu Chen Wei, Jesus K. Yamamoto-Furusho, Suk-Kyun Yang, Siew C. Ng () and Gilaad G. Kaplan ()
Additional contact information
Lindsay Hracs: University of Calgary
Joseph W. Windsor: University of Calgary
Julia Gorospe: University of Calgary
Michael Cummings: University of Calgary
Stephanie Coward: University of Calgary
Michael J. Buie: University of Calgary
Joshua Quan: University of Calgary
Quinn Goddard: University of Calgary
Léa Caplan: University of Calgary
Ante Markovinović: University of Calgary
Tyler Williamson: University of Calgary
Yvonne Abbey: Maidstone and Tunbridge Wells NHS Trust
Murdani Abdullah: Dr. Cipto Mangunkusumo Hospital
Maria T. Abreu: Cedars-Sinai Medical Center
Vineet Ahuja: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Raja Affendi Raja Ali: Sunway University
Mansour Altuwaijri: King Saud University
Domingo Balderramo: Instituto Universitario de Ciencias Biomédicas de Córdoba
Rupa Banerjee: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Eric I. Benchimol: The Hospital for Sick Children (SickKids)
Charles N. Bernstein: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Eduard Brunet-Mas: Institut d’Investigació I Innovació Parc Taulí (I3PT-CERCA)
Johan Burisch: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Vui Heng Chong: Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital
Iris Dotan: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Usha Dutta: Postgraduate Institute of Medical Education and Research
Sara El Ouali: Cleveland Clinic Abu Dhabi
Angela Forbes: University of Otago
Anders Forss: Karolinska Institutet
Richard Gearry: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Viet Hang Dao: Hanoi Medical University
Juanda Leo Hartono: National University of Singapore
Ida Hilmi: University Malaya
Phoebe Hodges: Queen Mary University of London
Gareth-Rhys Jones: Institute for Regeneration and Repair
Fabián Juliao-Baños: Pablo Tobon Uribe Hospital
Jamilya Kaibullayeva: JSC Research Institute of Cardiology and Internal Diseases of the Ministry of Health of the Republic of Kazakhstan
Paul Kelly: Queen Mary University of London
Taku Kobayashi: Kitasato University Kitasato Institute Hospital
Paulo Gustavo Kotze: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Peter L. Lakatos: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Charlie W. Lees: University of Edinburgh
Julajak Limsrivilai: Mahidol University
Bobby Lo: Copenhagen University Hospital—Amager and Hvidovre
Edward V. Loftus: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Jonas F. Ludvigsson: Karolinska Institutet
Joyce W. Y. Mak: The Chinese University of Hong Kong
YingLei Miao: The First Affiliated Hospital of Kunming Medical University
Ka Kei Ng: Conde S. Januário Hospital
Shinji Okabayashi: Kyoto University
Ola Olén: Karolinska Institutet
Remo Panaccione: University of Calgary
Mukesh Sharma Paudel: National Academy of Medical Sciences
Abel Botelho Quaresma: UNOESC Curso de Medicina: Universidade do Oeste de Santa Catarina
David T. Rubin: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Marcellus Simadibrata: Dr. Cipto Mangunkusumo Hospital
Yang Sun: The First Affiliated Hospital of Kunming Medical University
Hidekazu Suzuki: Tokai University School of Medicine
Martin Toro: HIGEA
Dan Turner: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Beatriz Iade: Cooperativa de Servicios Médicos (COSEM)
Shu Chen Wei: National Taiwan University Hospital and College of Medicine
Jesus K. Yamamoto-Furusho: National Institute of Medical Sciences and Nutrition and National Autonomous University of Mexico (UNAM)
Suk-Kyun Yang: University of Ulsan College of Medicine
Siew C. Ng: International Organization for the study of Inflammatory Bowel Disease (IOIBD)
Gilaad G. Kaplan: University of Calgary

Nature, 2025, vol. 642, issue 8067, 458-466

Abstract: Abstract During the twentieth century, inflammatory bowel disease (IBD) was considered a disease of early industrialized regions in North America, Europe and Oceania1. At the turn of the twenty-first century, IBD incidence increased in newly industrialized and emerging regions in Africa, Asia and Latin America, while the prevalence in early industrialized regions continued to grow steadily2–4. Changes in the incidence and prevalence denote the evolution of IBD across four epidemiologic stages: stage 1 (emergence), characterized by low incidence and prevalence; stage 2 (acceleration in incidence), marked by rapidly rising incidence and low prevalence; and stage 3 (compounding prevalence), where the incidence decelerates, plateaus or declines while the prevalence steadily increases. A fourth stage (prevalence equilibrium) has been proposed in which the prevalence slope plateaus due to demographic shifts in an ageing IBD population, but it has not yet been evidenced. To date, these stages have remained theoretical, lacking specific numerical indicators to define transition points. Here, using real-world data from 522 population-based studies encompassing 82 global regions and spanning more than a century (1920–2024), we show spatiotemporal transitions across stages 1–3 and model stage 4 progression. Understanding the evolution of IBD across epidemiologic stages enables healthcare systems to better anticipate the future worldwide burden of IBD.

Date: 2025
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DOI: 10.1038/s41586-025-08940-0

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