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. 2025 Jun 2;25:425. doi: 10.1186/s12876-025-04042-3

Global, regional, and national burden of inflammatory bowel disease in persons aged 60–89 years from 1992 to 2021

Zhou Zhang 1, Na Du 2, Chun-mei Xu 1, Wei Chen 1, Ting-ting-Chen 3, Yu Xiao 2,✉
PMCID: PMC12131378  PMID: 40457222

Abstract

Background

The global burden of inflammatory bowel disease (IBD) is increasing, but detailed data on older adults remain scarce.

Objective

This study describes trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of IBD among individuals aged 60–89 years from 1992 to 2021 at global, regional, and national levels, and forecasts the epidemiological status for 2030.

Methods

We used the Global Burden of Disease (GBD) database, covering 204 countries and territories. Temporal trends were analyzed using Joinpoint regression models. Decomposition analysis assessed the impacts of population growth, aging, and epidemiological changes. The Nordpred model forecasted 2030 incidence, prevalence, mortality, and DALYs of IBD among older adults.

Results

From 1992 to 2021, the global age-standardized incidence rate (ASIR) of IBD among older adults increased (AAPC 0.34). Conversely, the prevalence rate (ASPR) slightly decreased (AAPC − 0.04). Both mortality (ASMR) and DALYs significantly declined (AAPC − 0.60 and − 0.49, respectively). High SDI regions had the highest ASIR and ASPR, with Middle SDI regions experiencing the fastest ASIR growth. Population growth accounted for 117.77% of the overall increase in the IBD burden. By 2030, the incidence rate is expected to rise, but prevalence, mortality, and DALYs rates are predicted to decrease.

Conclusion

The incidence rate of IBD among older adults is rising, while prevalence, mortality, and DALYs rates are declining. Significant regional variations underscore the need for targeted public health policies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-025-04042-3.

Keywords: Inflammatory bowel disease, Disease burden, Global epidemiology, Sociodemographic index

Introduction

Inflammatory bowel disease (IBD) encompasses chronic inflammatory conditions of the gastrointestinal tract, specifically Crohn’s disease and ulcerative colitis. These diseases lead to persistent intestinal inflammation, causing tissue damage, ulceration, strictures, and fistulas. The pathogenesis of IBD is complex, involving interactions among genetic, immune, and environmental factors, and the gut microbiota [1–3].

Given that IBD predominantly affects adolescents and young adults, most prior research has concentrated on the disease burden across the entire age spectrum, particularly in children and adolescents [4–9]. However, the increasing incidence of IBD among older adults has shifted some focus toward this demographic, highlighting the need for more targeted studies. IBD among older adults has different clinical characteristics, disease progression, and treatment strategies compared to younger patients [10–12], due to factors such as declining physical function, comorbidities, and polypharmacy interactions [10, 13]. Chronic inflammation in older adults with IBD increases the risk of colorectal cancer and other malignancies. Additionally, their drug metabolism and tolerance differ from younger patients, necessitating more cautious treatment approaches [14]. Studies also show that older IBD patients are more prone to complications and have poorer treatment responses [15].

Given the global trend of population aging, studying the disease burden of IBD among older adults is crucial. However, detailed quantitative analyses at the global, regional, and national levels have been scarce over the past 30 years. This study uses data from the Global Burden of Disease (GBD) 2021 to describe the epidemiological status of IBD among older adults aged 60–89 years at global, regional, and national levels [16]. We systematically analyze the impact of demographic factors such as population growth and aging, as well as epidemiological changes, on the burden of IBD among older adults during this period, and predict the epidemiological trends for IBD among older adults by 2030.

Methods

Data sources

We sourced the data for this study from the GBD database. The GBD is an international collaborative project that assesses global health loss using standardized and integrated methods. It provides epidemiological data on diseases, injuries, and risk factors at global, regional, and national levels. Since 1990, the GBD has evolved into a comprehensive database covering 204 countries and territories.The GBD uses advanced statistical models and methods to integrate various data sources, including disease surveillance systems, population health surveys, medical records, and death registries. This integration generates health outcome estimates such as prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates. To ensure data quality and reliability, the GBD database undergoes multiple stages of data cleaning and validation, including consistency checks and statistical model calibration, to minimize errors and biases. For detailed information on the methodologies used in the Global Burden of Disease 2021, please refer to previous research [17–19].

Study population

The study period for data extraction spans from 1992 to 2021. The dataset includes global coverage, with regions classified by the Sociodemographic Index (SDI) and World Health Organization (WHO) regions. For this study, older adults are defined as individuals aged 60–89 years, based on GBD age stratification [18, 20]. Individuals aged 90 years and above were excluded because data for this group are aggregated into an open-ended category (“90+”), limiting modeling precision. In addition, estimates for the 90 + population are generally less stable due to smaller sample sizes and increased uncertainty in cause-of-death attribution. We extracted key indicators such as prevalence, incidence, DALYs, and mortality rates of IBD among older adults from the GBD database. These rates were age-standardized to the GBD world population to accurately reflect the disease burden of IBD among older adults.

Statistical analysis

Joinpoint regression model

We used the Joinpoint regression model to identify and quantify changes in temporal trends. This model employs segmented linear regression, with each segment representing a period of trend change, expressed as the annual percent change (APC) [21]. We determined slope parameters using maximum likelihood estimation. The analysis focused on the average annual percent change (AAPC) to measure trend changes over the study period. We utilized Joinpoint software (version 5.2.0), developed by the National Cancer Institute (NCI), to determine optimal Joinpoint positions through a grid search method. We assessed the statistical significance of the models using Monte Carlo permutation tests.

Decomposition analysis

To understand the changes in the burden of IBD among older adults, we performed decomposition analysis. This method breaks down the burden changes into components driven by population growth, aging, and epidemiological changes. The steps involved include: calculating the total change in the IBD burden from 1992 to 2021; estimating the contributions of population growth and aging; and evaluating the contributions of epidemiological changes after accounting for these factors. This approach quantifies the impact of various factors on changes in IBD incidence, prevalence, DALYs, and mortality. We used R software (version 4.3.2) for data processing and graphical plotting to ensure accuracy and effective visualization.

Nordpred prediction model

To forecast the future burden of IBD among older adults, we utilized the Nordpred prediction model. This model, based on time series data, captures both long-term trends and short-term fluctuations [22–24]. The steps involved include training the model using data from 1992 to 2021, and then applying it to predict the incidence, prevalence, DALY, and mortality rates of IBD among older adults globally for the year 2030. The Nordpred model combines historical trends with current data to provide reliable estimates of future health burdens. All prediction analyses were performed using R software (version 4.3.2) to ensure accuracy and reproducibility of the results.

Results

Age-standardized incidence rate, Age-standardized prevalence rate, Age-standardized mortality rate, and Age-standardized Disability-Adjusted life year

Age-standardized incidence rate (ASIR)

The global ASIR for IBD among older adults increased from 7.98 (95% CI: 6.13–10.06) in 1992 to 8.77 (95% CI: 6.71–10.99) in 2021, with an AAPC of 0.34 (95% CI: 0.29–0.39) (Table 1). In 2021, High SDI regions had the highest ASIR at 18.24 (95% CI: 14.27–22.30), with an AAPC of 0.58 (95% CI: 0.53–0.63). Middle SDI regions had the lowest ASIR at 4.17 (95% CI: 3.09–5.40), but the highest AAPC at 1.36 (95% CI: 1.33–1.40). Among WHO regions, the Americas had the highest ASIR at 18.12 (95% CI: 14.29–21.99), with an AAPC of 0.27 (95% CI: 0.17–0.37). The Western Pacific region had the lowest ASIR at 2.96 (95% CI: 2.22–3.79), with an AAPC of 1.06 (95% CI: 0.99–1.13) (Table 1). In 2021, New Zealand had the highest ASIR at 45.31 (95% CI: 35.90-55.29), followed by Canada at 38.90 (95% CI: 29.91–48.52). Mexico had the lowest ASIR at 0.35 (95% CI: 0.25–0.47) (Supplementary Table 1, Fig. 1). Between 1992 and 2021, Hungary (AAPC: 2.18, 95% CI: 2.00-2.36) and Libya (AAPC: 2.02, 95% CI: 1.80–2.24) saw over a 200% increase in IBD incidence (Fig. 1 and Supplementary Tables 3–4).

Table 1.

Age-standardized incidence and prevalence rates of older adults inflammatory bowel disease in 1992 and 2021, and estimated annual percentage change from 1992 to 2021

Age-standardized Incidence per 100 000 population (95%CI) 1992–2021 Age-standardized Prevalence per 100 000 population (95%CI) 1992–2021
1992 2021 AAPC (95%CI) P 1992 2021 AAPC (95%CI) P
Global 7.98 (6.13,10.06) 8.77 (6.71,10.99) 0.34 (0.29,0.39) < 0.01 118.55 (96.76,143.11) 117.15 (94.76,141.78) -0.04 (-0.07,-0.02) < 0.01
SDI
 Low SDI 5.02 (3.71,6.56) 6.32 (4.73,8.16) 0.83 (0.76,0.90) < 0.01 46.68 (35.91,59.49) 54.84 (42.24,70.02) 0.58 (0.54,0.61) < 0.01
 Low-middle SDI 7.2 (5.34,9.36) 8.49 (6.31,11.00) 0.59 (0.55,0.62) < 0.01 61.29 (47.35,78.15) 73.16 (56.78,92.96) 0.62 (0.60,0.64) < 0.01
 Middle SDI 2.83 (2.08,3.69) 4.17 (3.09,5.40) 1.36 (1.33,1.40) < 0.01 29.01 (22.55,36.80) 40.41 (31.45,51.36) 1.15 (1.10,1.20) < 0.01
 High-middle SDI 5.55 (4.18,7.13) 5.79 (4.3,7.49) 0.13 (0.07,0.19) < 0.01 80.63 (64.42,99.55) 68.2 (53.36,85.52) -0.60 (-0.71,-0.48) < 0.01
 High SDI 15.45 (12.11,19.09) 18.24 (14.27,22.3) 0.58 (0.53,0.63) 0.02 270.13 (223.72,321.47) 303.53 (248.83,360.24) 0.42 (0.35,0.49) < 0.01
WHO Region
 African Region 2.77 (2.05,3.59) 3.31 (2.46,4.28) 0.62 (0.59,0.64) < 0.01 31.32 (24.35,39.47) 38.14 (29.84,47.66) 0.68 (0.65,0.71) < 0.01
 Eastern Mediterranean Region 5.92 (4.35,7.74) 6.68 (4.88,8.71) 0.43 (0.38,0.49) < 0.01 61.70 (47.78,78.66) 72.30 (55.78,91.69) 0.57 (0.49,0.64) < 0.01
 European Region 10.44 (8.1,13.12) 12.50 (9.47,15.83) 0.62 (0.56,0.68) < 0.01 175.07 (142.68,211.87) 202.01 (162.92,245.92) 0.48 (0.4,0.56) < 0.01
 Region of the Americas 16.72 (13.01,20.67) 18.12 (14.29,21.99) 0.27 (0.17,0.37) 0.057 277.23 (228.99,328.46) 270.04 (220.47,319.7) -0.09 (-0.12,-0.05) < 0.01
 South-East Asia Region 7.86 (5.83,10.21) 9.42 (7.03,12.18) 0.65 (0.59,0.72) < 0.01 69.56 (53.8,88.64) 84.39 (65.32,107.59) 0.68 (0.65,0.71) < 0.01
 Western Pacific Region 2.18 (1.64,2.78) 2.96 (2.22,3.79) 1.06 (0.99,1.13) < 0.01 29.46 (23.57,36.11) 34.37 (27.28,42.31) 0.54 (0.44,0.65) < 0.01
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Fig. 1.

Fig. 1

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Global Burden of Inflammatory Bowel Disease among older adults in 204 Countries and territories in 2021. (A) Age-standardized Incidence Rate; (B) Age-standardized Prevalence Rate; (C) Age-standardized Mortality Rate; (D) Age-standardized DALYs

Age-standardized prevalence rate (ASPR)

From 1992 to 2021, the global ASPR for IBD among older adults peaked in 2010 before declining. The ASPR was 118.55 (95% CI: 96.76-143.11) in 1992, reached 122.86 (95% CI: 100.95-147.02) in 2010, and decreased to 117.15 (95% CI: 94.76-141.78) in 2021, with an AAPC of -0.04 (95% CI: -0.07 to -0.02) (Table 1). In 2021, High SDI regions had the highest ASPR at 303.53 (95% CI: 248.83-360.24), with an AAPC of 0.42 (95% CI: 0.35–0.49). Middle SDI regions had the lowest ASPR at 40.41 (95% CI: 31.45–51.36), but a higher AAPC of 1.15 (95% CI: 1.10–1.20)(Table 1). The Americas had the highest ASPR among WHO regions at 270.04 (95% CI: 220.47–319.70), with an AAPC of -0.09 (95% CI: -0.12 to -0.05). The Western Pacific region had the lowest ASPR at 34.37 (95% CI: 27.28–42.31), with an AAPC of 0.54 (95% CI: 0.44–0.65) (Table 1). In 2021, Canada had the highest ASPR at 662.64 (95% CI: 533.52-798.92), followed by Norway at 571.56 (95% CI: 479.30-670.10) (Supplementary Table 1, Fig. 1). Mexico had the lowest ASPR at 3.58 (95% CI: 2.71–4.64). From 1992 to 2021, France experienced more than a 200% increase in IBD prevalence, with an AAPC of 2.34 (95% CI: 2.24–2.43) (Fig. 1 and Supplementary Tables 3–4).

Age-standardized mortality rate (ASMR)

From 1992 to 2021, the global ASMR for IBD among older adults declined from 3.05 (95% CI: 2.55–3.42) to 2.61 (95% CI: 2.26–2.98), with an AAPC of -0.60 (95% CI: -0.79 to -0.40) (Supplementary Table 2). In 2021, High SDI regions had the highest ASMR at 4.25 (95% CI: 3.69–4.63), with an AAPC of 0.37 (95% CI: 0.02–0.72). Middle SDI regions had the lowest ASMR at 1.74 (95% CI: 1.35–2.09), with an AAPC of -1.54 (95% CI: -1.78 to -1.29). Among WHO regions, Europe had the highest ASMR at 4.43 (95% CI: 3.85–4.84), with an AAPC of 0.64 (95% CI: 0.34–0.94). The Western Pacific had the lowest ASMR at 1.47 (95% CI: 1.14–2.03), with an AAPC of -2.19 (95% CI: -2.34 to -2.04) (Supplementary Table 2). The Netherlands recorded the highest ASMR at 10.58 (95% CI: 8.52–12.52), followed by Germany at 9.94 (95% CI: 7.97–11.73). Singapore had the lowest ASMR at 0.14 (95% CI: 0.11–0.17). From 1992 to 2021, countries with over a 200% increase in IBD mortality included Australia (AAPC: 3.69, 95% CI: 2.56–4.84), Germany (AAPC: 3.11, 95% CI: 2.05–4.18), and Italy (AAPC: 2.48, 95% CI: 2.08–2.89) (Fig. 1 and Supplementary Tables 3–4).

Age-standardized Disability-Adjusted life year (ASDR)

From 1992 to 2021, the global ASDR for IBD among older adults decreased from 67.89 (95% CI: 57.55–77.77) to 59.32 (95% CI: 50.99–68.45), with an AAPC of -0.49 (95% CI: -0.67 to -0.30) (Supplementary Table 2). In 2021, High SDI regions had the highest ASDR at 111.25 (95% CI: 93.67-129.55), with an AAPC of 0.41 (95% CI: 0.07–0.76). Middle SDI regions had the lowest ASDR at 35.04 (95% CI: 28.06–41.64), with an AAPC of 1.15 (95% CI: 1.10–1.20)(Supplementary Table 2). Among WHO regions, Europe had the highest ASDR at 99.54 (95% CI: 85.11-113.67), with an AAPC of 0.44 (95% CI: 0.26–0.63). The Western Pacific had the lowest ASDR at 28.14 (95% CI: 22.25–36.87), with an AAPC of -1.87 (95% CI: -2.00 to -1.73) (Supplementary Table 2). The Netherlands had the highest ASDR at 226.07 (95% CI: 182.69-274.02), followed by Germany at 218.29 (95% CI: 178.62-258.76), and the United States at 160.97 (95% CI: 136.53-187.43). Singapore had the lowest ASDR at 4.57 (95% CI: 3.51–5.80). From 1992 to 2021, Germany saw more than a 200% increase in DALYs related to IBD among older adults (AAPC: 2.18, 95% CI: 1.41–2.95) (Fig. 1 and Supplementary Tables 3–4).

Joinpoint analysis

The ASIR showed an overall upward trend with an AAPC of 0.34. It remained stable from 1992 to 1996 (APC = -0.01), increased from 1996 to 1999 (APC = 0.81), declined from 1999 to 2005 (APC = -0.13), rose from 2005 to 2009 (APC = 1.10), slowed from 2009 to 2014 (APC = 0.63), and slightly increased from 2014 to 2021 (APC = 0.10). From 1992 to 2021, The AAPC was 0.31 for males and 0.36 for females. The ASPR exhibited an overall downward trend with an AAPC of -0.04. It decreased from 1992 to 2005 (APC = -0.18), increased from 2005 to 2010 (APC = 1.25), decreased from 2010 to 2016 (APC = -0.63), and further declined from 2016 to 2021 (APC = -0.25). From 1992 to 2021, The AAPC was − 0.01 for males and − 0.07 for females (Fig. 2).

Fig. 2.

Fig. 2

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Joinpoint Regression Analysis of Global Inflammatory Bowel Disease among older adults from 1992 to 2021. (A) Age-standardized Incidence Rate; (B) Age-standardized Prevalence Rate; (C) Age-standardized Mortality Rate; (D) Age-standardized DALY

The ASMR declined with an AAPC of -0.60. It decreased from 1992 to 1998 (APC = -0.34), increased from 1998 to 2003 (APC = 1.56), decreased from 2003 to 2012 (APC = -0.53), and saw the fastest decline from 2012 to 2021 (APC = -2.00). From 1992 to 2021, The AAPC was − 0.46 for males and − 0.70 for females. The DALYs rate also showed an overall downward trend with an AAPC of -0.49. It decreased from 1992 to 1998 (APC = -0.47), increased from 1998 to 2003 (APC = 0.63), decreased from 2003 to 2012 (APC = -0.22), and experienced significant declines from 2012 to 2015 (APC = -1.96) and 2015 to 2021 (APC = -1.08). From 1992 to 2021, The AAPC was − 0.40 for males and − 0.53 for females (Fig. 2).

Decomposition analysis

Over the past 30 years, DALYs have significantly increased. High SDI regions saw the largest rise among the different SDI regions. When classified by WHO regions, the Americas showed the greatest increase. Population growth and aging were the main drivers of the global increase in DALYs, contributing 117.77% and 4.8%, respectively. Population growth had the most substantial impact in High-middle SDI regions (164.69%) and the Western Pacific region (210.56%). In contrast, epidemiological changes led to a reduction in global DALYs by -22.57%. This reduction was particularly notable in High-middle SDI regions (-74.14%) and the Western Pacific region (-136.00%) (Supplementary Tables 3 and Fig. 3).

Fig. 3.

Fig. 3

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Changes in Global DALYs for Inflammatory Bowel Disease among older adultsfrom 1992 to 2021 Based on Population-Level Determinants: Population Growth, Aging, and Epidemiological Changes. The black dot represents the overall change contributed by all three factors combined. For each factor, the size of positive values indicates the corresponding increase caused by that factor, and the size of negative values indicates the corresponding decrease caused by the related factor

Forecast analysis

From 1992 to 2021, the global incidence rate of IBD among older adults showed an increasing trend and is projected to continue rising through 2030. In 2021, the global incidence rate was 8.77 cases per 100,000 population and is expected to increase to 8.81 cases per 100,000 population by 2030. Conversely, the global prevalence rate is anticipated to decline from 117.15 cases per 100,000 population in 2021 to 112.75 cases per 100,000 population by 2030. The global DALYs rates are forecasted to drop from 59.32 per 100,000 population in 2021 to 54.58 per 100,000 population by 2030. Additionally, the global mortality rate is projected to decrease from 2.61 cases per 100,000 population in 2021 to 2.35 cases per 100,000 population by 2030 (Fig. 4).

Fig. 4.

Fig. 4

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Projections of Global Incidence, Prevalence, Mortality, and DALYs for Inflammatory Bowel Disease among older adults. (A) Number and age-standardized rate of incidence; (B) Number and age-standardized rate of prevalence; (C) Number and age-standardized rate of mortality; (D) Number and age-standardized rate of DALYs

Discussion

This study is the first to comprehensively examine trends in the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of among older adults from 1992 to 2021 using data from the GBD 2021 database at global, regional, and national levels. The GBD 2021 database offers enhanced case definitions, improved data collection methods, and more efficient model fitting techniques compared to the GBD 2019 database, increasing the accuracy and reliability of estimates. Therefore, our study likely represents the most comprehensive and up-to-date analysis of the burden of among older adults, providing a crucial basis for precise and thorough disease burden assessments.

Overall, the ASIR of among older adults increased, while the ASPR, ASMR, and ASDR declined. Trends in incidence, mortality, and DALYs across all age groups, including children and adolescents, align with those observed in older adults [5, 25]. The ASPR in the older adults slightly declined, whereas it increased for all age groups and for children and adolescents during the same period [5, 25]. These variations across different SDI and WHO regions reflect progress made in IBD management and treatment in different areas.

From 1992 to 2021, the global ASIR of IBD among older adults increased with an average annual percentage change (AAPC) of 0.34%. High SDI regions had significantly higher ASIRs compared to other SDI regions, likely due to better diagnostic capabilities, greater access to healthcare resources, and lifestyle factors. Although the ASIR in Middle SDI regions was lower, its AAPC was higher, indicating a rapid increase in incidence rates. This rapid increase can be attributed to improved IBD detection rates, economic development, rapid urbanization, and the adoption of Western dietary habits in emerging industrialized countries [1, 26]. The incidence rate in these countries may reach the levels seen in Western countries in the coming decades [27–29].

Prevalence rates showed significant regional differences. The ASPR in High SDI regions was 303.53 per 100,000, much higher than the 40.41 per 100,000 in Middle SDI regions. However, the AAPC in High SDI regions was 0.42 per 100,000, lower than the 1.15 per 100,000 in Middle SDI regions. According to Ng et al., the global epidemiology of IBD progresses through four distinct stages: emergence, accelerating incidence, compounded prevalence, and eventual prevalence equilibrium [27]In 2020, low-resource countries such as India and several nations in sub-Saharan Africa were in the emergence stage, marked by limited diagnostic capacity and underrecognition of cases due to healthcare constraints. Countries undergoing rapid industrialization, including China, Malaysia, and parts of South America, were in the accelerating incidence stage—characterized by increasing incidence but still relatively low prevalence—reflecting the early stages of IBD system development and surveillance infrastructure. In contrast, high-income countries such as Canada, the United Kingdom, and Nordic nations have transitioned into the compounded prevalence stage, where incidence has plateaued but prevalence continues to rise as a result of chronic disease accumulation and improved survival. These countries benefit from established healthcare systems, widespread access to biologic therapies, and long-term disease management strategies.

However, despite the rising incidence of IBD among older adults, the global ASPR exhibited a slight downward trend. This apparent discrepancy may be explained by the cohort replacement effect. According to our APC model of prevalence (Supplementary Fig. 1), more recent birth cohorts entering older adulthood appear to have a lower cumulative prevalence of IBD than earlier cohorts. As these lower-prevalence cohorts gradually replace higher-prevalence ones in the aging population, the overall ASPR may decline even as incidence continues to increase. This dynamic highlights the importance of considering long-term generational shifts in interpreting current disease burden trends among older adults.

The global mortality rate for among older adults declined over the study period, with an AAPC of -0.60%. This trend was especially evident in High-middle and Middle SDI regions, reflecting significant progress in IBD treatment and management worldwide. The introduction of biologics has significantly improved IBD treatment strategies, enhancing patient quality of life and significantly reducing surgical intervention rates [30–32]. However, older adults use biologics less frequently than younger patients [33, 34]. This may be due to physicians perceiving the disease as milder in the older adults [35], their familiarity and trust in the safety of corticosteroids and 5-aminosalicylic acid [36], and concerns about the potential side effects of biologics in older adults [37]. Interestingly, certain High SDI countries such as Germany, Italy, and Australia exhibited increasing IBD mortality trends. This may reflect multiple factors: the long-standing accumulation of older IBD patients with complex disease histories, increased risk of long-term complications such as colorectal cancer or infections, and more comprehensive cause-of-death certification systems that improve attribution accuracy. Additionally, lifestyle and dietary factors prevalent in High SDI settings may further exacerbate disease burden. These nuances suggest that even in well-resourced settings, continued vigilance and age-tailored management—particularly in cancer surveillance and comorbidity control—remain essential.

The global DALY for among older adults also showed a steady decline, indicating a reduction in the disease’s negative impact on patients’ quality of life. Studies have demonstrated changes in the epidemiological pattern of IBD, with a decreased contribution of premature mortality to the overall IBD burden, while the impact of disability has increased [38]. This shift is primarily due to new treatment options, improved healthcare services, the widespread adoption of multidisciplinary care, the broad application of guidelines, and increased disease awareness, which have collectively delayed IBD-related mortality to older ages.

Joinpoint analysis indicated that the incidence rate for males was consistently slightly higher than for females. Meta-analyses suggest that the incidence and severity of Crohn’s disease are generally higher in females, while ulcerative colitis is more common and severe in males [39]. Environmental and geographic factors may significantly influence gender differences in IBD epidemiology [40]. For example, Crohn’s disease and ulcerative colitis are more prevalent in males in the Asia-Pacific region. The decline in mortality and DALY rates was more pronounced in females, with an AAPC of -0.70% for mortality rates and − 0.53% for DALYS rates, compared to -0.46% and − 0.40% for males, respectively. This suggests that females have shown more significant improvements in these indicators, possibly due to higher utilization of healthcare resources and greater emphasis on health management [41]. These findings highlight the importance of considering gender factors in IBD management, to optimize treatment outcomes and improve long-term prognosis.

Decomposition analysis identified population growth as the primary driver of the global and SDI region-specific burden of among older adults from 1992 to 2021. Additionally, improvements in disease management and treatment strategies have helped reduce mortality and DALYs. Low-middle and Low SDI regions experienced an increased disease burden due to population growth, with limited healthcare resources resulting in minimal improvements in mortality and DALYs despite epidemiological changes. Existing literature suggests that although older adults in these regions have shorter life expectancies, they still bear a high disease burden [42]. Our findings emphasize the importance of targeted public health policies and interventions tailored to different regions. Specifically, Low and Low-middle SDI regions need international support and resource allocation to promote healthy aging, enhance healthcare quality and accessibility, and effectively reduce the global burden of among older adults.

In Low-middle and Low SDI regions, managing IBD in older adults presents multifaceted challenges, particularly regarding healthcare accessibility, diagnostic limitations, and underreporting. Limited infrastructure, lack of universal health insurance, and high out-of-pocket costs hinder access to timely diagnosis and effective therapies, including biologics, which remain prohibitively expensive in many low-resource settings [43, 44]. Diagnostic difficulties are further compounded by low awareness of IBD and frequent misdiagnosis as other gastrointestinal conditions such as intestinal tuberculosis, especially in regions with high infectious disease burdens like sub-Saharan Africa [45]. Inadequate diagnostic capacity—due to scarcity of trained specialists and endoscopic services—also delays detection and disease monitoring [43]. These systemic limitations likely contribute to persistent underestimation of disease burden and suboptimal outcomes in these settings.

Projections based on data from 1992 to 2021 indicate that the global incidence rate of among older adults will continue to rise by 2030. However, the prevalence, DALYs, and mortality rates are all expected to decline, suggesting some alleviation in the global burden of IBD among older adults. These projections highlight the need for continuous optimization of treatment strategies and enhancement of disease management.

It is also important to note that the final years of our study period (2020–2021) coincided with the COVID-19 pandemic. Global healthcare systems experienced significant disruptions during this time, which may have temporarily affected IBD diagnosis and management among older adults—for instance, through reduced access to colonoscopy or delayed healthcare-seeking behaviors. Although our joinpoint analysis did not identify 2020 as an outlier, these pandemic-related factors may have introduced short-term deviations in trend patterns that warrant cautious interpretation.

Our findings have several important implications for clinical practice and public health interventions. Given the increasing incidence of IBD among older adults, healthcare providers should be vigilant regarding the unique management challenges in this population, such as increased risks of polypharmacy, drug interactions, and comorbidities. Individualized treatment approaches, considering patient-specific factors such as frailty and treatment tolerability, are essential for optimizing outcomes in older IBD patients. Furthermore, public health strategies should prioritize resource allocation to enhance access to biologics and nutritional support, particularly in regions with limited healthcare infrastructure. Early detection strategies, including regular colorectal cancer screening and proactive therapeutic drug monitoring, may further improve clinical outcomes by addressing disease progression and reducing complications.

Conclusion

From 1992 to 2021, the global ASIR of IBD among older adults steadily increased, while both the ASMR and ASDR showed a declining trend. The ASPR peaked in 2010 and then declined. Significant variations in disease burden were observed across different regions and countries. High SDI regions reported the highest levels of ASIR, ASPR, ASMR, and ASDR. In contrast, Middle SDI regions had lower ASIR but experienced the fastest rate of increase. Projections indicate that by 2030, the incidence rate of IBD among older adults will continue to rise. However, optimizing disease management and treatment strategies is expected to improve patients’ quality of life. To address the global burden of among older adults, targeted public health policies must be formulated for different regions. In particular, Low-middle and Low SDI regions, where medical resources are scarce, require strengthened international cooperation and increased resource investment to promote healthy aging and improve the quality of healthcare services.

Limitations

Despite providing a comprehensive analysis, this study has several limitations. First, the estimates were derived from the Global Burden of Disease (GBD) 2021 model, which synthesizes heterogeneous data sources through standardized modeling approaches. Although correction methods such as DisMod-MR 2.1 and MR-BRT were applied, residual biases and uncertainties, particularly in Low and Middle SDI settings with sparse data, may affect the accuracy of the estimates. Second, the GBD 2021 database does not distinguish between Crohn’s disease and ulcerative colitis. As a result, subtype-specific trends could not be evaluated, potentially obscuring important epidemiological differences in older adults. Third, individuals aged 90 years and above were excluded because data for this group are aggregated into an open-ended “90+” category, limiting modeling precision. Moreover, estimates for the 90 + population are less stable due to small sample sizes and greater uncertainty in cause-of-death attribution. Fourth, the future projections to 2030 were based on historical trends using the Nordpred model and did not account for potential changes such as new therapeutic developments, health policy shifts, or unforeseen global events. Similarly, Joinpoint regression assumes piecewise linear trends and may not fully capture nonlinear or abrupt changes in incidence or burden. Both models are sensitive to data variability and rely on assumptions that may not hold in all settings. Hence, the forecasted values should be interpreted with caution. Fifth, the burden of IBD among older adults might be underestimated. Disability weights used in GBD may not fully capture frailty, postoperative complications, or deaths indirectly related to IBD, such as those from colorectal cancer or infections. Finally, this study treated adults aged 60–89 years as a homogeneous group, without stratifying by narrower age ranges or disease duration. Given the heterogeneity within this population, future studies using individual-level clinical data are warranted to refine these findings.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1 (13.2KB, xlsx)
Supplementary Material 2 (11.8KB, xlsx)
Supplementary Material 3 (322.5KB, xls)
Supplementary Material 4 (89.2KB, xlsx)
Supplementary Material 5 (183KB, png)

Acknowledgements

We sincerely thank the editor and reviewers for their valuable feedback, which has greatly improved the quality of our manuscript.

Abbreviations

ASIR

Age-Standardized Incidence Rate

AAPC

Average Annual Percentage Change

ASPR

Age-Standardized Prevalence Rate

ASMR

Age-Standardized Mortality Rate

DALYs

Disability-Adjusted Life Years

SDI

Sociodemographic Index

GBD

Global Burden of Disease

NCI

National Cancer Institute

WHO

World Health Organization

Author contributions

Zhou Zhang: Conceptualization, Investigation, Data curation, Writing - Original draft preparation. Na Du: Formal analysis, Data curation. Chun-mei Xu: Methodology, Data curation. Wei Cheng: Investigation, Resources, Validation. Tingting Chen: Data analysis, Statistical validation, Writing - Review and Editing. Yu Xiao: Conceptualization, Methodology, Writing - Review and Editing.

Funding

This research received no specific grant from any funding agency in the public, commercial or not for-profit sectors.

Data availability

The data can be obtained from a public, open-access database. Information regarding data access policies and procedures can be found at https://ghdx.healthdata.org/gbd-2021.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1 (13.2KB, xlsx)
Supplementary Material 2 (11.8KB, xlsx)
Supplementary Material 3 (322.5KB, xls)
Supplementary Material 4 (89.2KB, xlsx)
Supplementary Material 5 (183KB, png)

Data Availability Statement

The data can be obtained from a public, open-access database. Information regarding data access policies and procedures can be found at https://ghdx.healthdata.org/gbd-2021.

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