Skip to main content
NCBI home page
Medicine logoLink to Medicine
. 2025 Sep 12;104(37):e44580. doi: 10.1097/MD.0000000000044580

The rising burden of inflammatory bowel disease in East Asia’s aging population: A cross-sectional study

Qingbo Yan a, Yiyong Chen a, Huayu Zhang a, Wenping Liu a, Jiang Liu a,*
PMCID: PMC12440409  PMID: 40958214

Abstract

East Asia faces a “double challenge” in both aging of population and the increasing incidence of inflammatory bowel disease (IBD). This study aimed to investigate the distribution and temporal trends of older adults with IBD (OA-IBD) in East Asia and explore associated influencing factors. The data (including prevalence, and disability-adjusted life years [DALYs]) of patients with IBD aged ≥60 years for East Asia (including China, Japan, Mongolia, the Republic of Korea, and the Democratic People’s Republic of Korea) were extracted from the Global Burden of Disease 2021 database. The joinpoint model was used to analyze the temporal trends of OA-IBD burden. Decomposition analysis was then applied to identify the drivers of the burden of OA-IBD. Additionally, the relationship between OA-IBD burden and the socio-demographic index (SDI) was examined. Between 1990 and 2021, the cases of prevalence of OA-IBD in East Asia increased from 27,167 to 93,572, while DALYs number rose from 59,084 to 95,271. Among the 5 studied countries, the age-standardized prevalence rate showed the most rapid increase in China, whereas Mongolia and the Democratic People’s Republic of Korea experienced a decline. During the same period, the age-standardized DALYs rate of OA-IBD decreased significantly across all countries. The decomposition analysis showed that population growth was the primary driver of the increased OA-IBD burden. Furthermore, age-standardized prevalence rate was positively associated with SDI, while age-standardized DALYs rate showed a negative association with SDI. The burden of OA-IBD in East Asia has increased significantly from 1990 to 2021, with notable regional variations.

Keywords: Crohn disease, disease burden, inflammatory bowel disease, older adults, ulcerative colitis

1. Introduction

Inflammatory bowel disease (IBD) is a chronic and complex disease that includes ulcerative colitis (UC) and Crohn’s disease (CD). Although IBD occurs primarily in young adults, it can affect individuals of all ages. Among them, individuals aged 60 years and older with IBD are defined as older adults with IBD (OA-IBD).[1,2] Compared with younger patients with IBD, the manifestations of OA-IBD lack specificity, mainly presenting with weight loss, anemia, and abdominal pain. Therefore, insufficient knowledge of OA-IBD may lead to an incorrect diagnosis.[2,3] A systematic review demonstrates that diagnostic delays in IBD significantly increase complication risks, demonstrating structuring (odds ratio [OR] = 1.88), penetrating disease (OR = 1.64), and surgery (OR = 2.24) in CD, while elevating colectomy odds in UC (OR = 4.13).[4] Furthermore, the elderly often have comorbidities such as frailty and chronic diseases, which may further increase the medical burden and complexity of OA-IBD. Frailty is independently associated with a higher mortality risk (HR: 1.57) and greater hospitalization burden in IBD patients.[5]

East Asia, one of the most densely populated regions globally, is home to almost one-fifth of the global population. In the context of global trend of aging, East Asian countries are confronted with the grave issue of population aging. Japan, for instance, is the world’s most aged nation, with individuals aged 65 and older accounting for 29.3% of its total population.[6] In China and other East Asian countries, the aging problem has become increasingly prominent.[7] Concurrently, various evidence has shown a sharp increase in the incidence of IBD in East Asia.[8,9] Due to the combined effect of these factors, the disease burden of OA-IBD in East Asia is becoming increasingly severe. However, there is currently a lack of research on OA-IBD in East Asia. Therefore, it is necessary to advance the understanding of the current situation of OA-IBD, which will facilitate the development of more targeted medical policies and services to improve the quality of life for patients with OA-IBD, thereby promoting the healthy development of society.

In this study, we conducted a comprehensive analysis of the burden of OA-IBD in East Asia using data from the global burden of disease (GBD) Study 2021. Our goal was to gain a deeper understanding of the disease distribution and temporal trends in the region. This understanding will help enhance clinical management, optimize resource allocation, and guide policy development for OA-IBD patients in East Asia, addressing region-specific healthcare challenges.

2. Methods

2.1. Overview

The GBD Study, developed and maintained by the GBD Collaboration, is a publicly available database that systematically assesses the global health burden of various diseases, injuries, and risk factors.[10] It pooled raw disease and risk data from national statistical offices, the World Health Organization (WHO), academic research institutions, and other relevant organizations. The GBD database provides invaluable data support for global health analysis, disease burden assessment, and health policy formulation.

2.2. Data source

The data used in this study were derived from the GBD 2021 database (https://ghdx.healthdata.org/gbd-2021) published on the official website of the Institute for Health Statistics and Evaluation.[10] In our study, we extracted estimates and 95% uncertainty interval (UI) of prevalence, and disability-adjusted life years (DALYs) for IBD in older adults aged ≥ 60 years as measures of the burden in East Asia (includes China, Japan, Mongolia, the Republic of Korea, and the Democratic People’s Republic of Korea (DPRK)). Given the variations in age structure across 5 countries, we calculated age-standardized prevalence rate (ASPR) and age-standardized DALYs rate (ASDR) for a more accurate and comparable assessment. In addition, we collected the socio-demographic index (SDI) of each country from 1990 to 2021. The SDI is a composite measure of socio-economic development, based on per capita income, education, and fertility rates, used to compare development levels across countries.[11]

2.3. Definition of OA-IBD

In GBD 2021, the specific diagnostic criteria for IBD were classified according to the International Classification of Diseases (ICD) ICD-10 codes K50-K52, K52.8-K52.9, M09.1, and ICD9 555 to 556.9, 558 to 558.0, 569.5. According to the WHO, older people usually refer to those aged 60 years and older.[12] Therefore, OA-IBD include aged ≥ 60 patients newly diagnosed with IBD and aged ≥ 60 patients with IBD (onset at age < 60 years).[13]

2.4. Statistical analysis

First of all, the “Joinpoint” software, provided by the Surveillance Research Program of the National Cancer Institute of the United States, was used to analyze the temporal trend of the burden (including prevalence and DALYs) of OA-IBD in East Asia. As an important indicator of joinpoint analysis, average annual percentage change (AAPC) and its 95% CI were used to describe the changing trend between 1990 and 2021. Secondly, we discussed the differences in disease burden caused by gender and age. Then, to understand the drivers of OA-IBD burden in East Asia, we conducted a decomposition analysis.[14,15] The decomposition analysis divides the overall difference into 3 factors, including population growth, population aging, and epidemiological changes. In addition, we examined the impact of socio-economic factors on the burden of OA-IBD. All analyses and visualizations were performed using Joinpoint Regression Software (Version 5.0.2; National Cancer Institute, Bethesda), R (Version 4.2.3; R Foundation for Statistical Computing, Vienna, Austria), and GraphPad Prism (Version 10.2.1; GraphPad Software, San Diego), with statistical significance defined as P < .05. Since this study is a reanalysis of GBD 2021 and no new data was collected, no additional ethical approval is required.

3. Result

3.1. Overview of the OA-IBD burden

Overall, the number of OA-IBD cases in East Asia increased from 27,167 in 1990 to 93,572 in 2021, with the corresponding DALYs increased from 59,084 to 95,271. Among the 5 countries, Japan had the highest number of OA-IBD cases in 1990 (14,039 [95% UI: 11,212 to 17,498]). By 2021, the highest number of OA-IBD cases was observed in China (47,114 [95% UI: 36,367 to 60,026]), followed by Japan (30,603 [95% UI: 24,326 to 38,203]), while the lowest country was in Mongolia (187 [95% UI: 144 to 241]) (Table 1 and Fig. 1A and B). However, after population standardization, the highest ASPR in 2021 was recorded in the Republic of Korea (121.29 [95% UI: 96.07 to 151.35] per 100,000) while the lowest ASPR was in the DPRK (9.58 [95% UI: 7.18 to 12.75] per 100,000). From 1990 to 2021, the ASPR of OA-IBD increased in China, Japan, and the Republic of Korea, with AAPCs of 1.75 (95% CI: 1.61–1.89, P < .001), 0.29 (95% CI: 0.19–0.39, P < .001), and 1.70 (95% CI: 1.60–1.79, P < .001), respectively. In contrast, the ASPR decreased in Mongolia, and the DPRK, with AAPCs of − 0.07 (95% CI: −0.13 to − 0.01, P = .023), and − 0.06 (95% CI: −0.08 to −0.04, P < .001), respectively (Table 1 and Fig. 1C). Similar to the prevalence, the highest DALYs of OA-IBD was also found in China (79,120 [95% UI: 59,996–109,284]), followed by Japan (9536 [95% UI: 7558 to 11,698]), while the lowest was observed in Mongolia (101 [95% UI: 62 to 154]). The highest ASDR of OA-IBD in 2021 was in the DPRK (45.30 [95% UI: 23.09 to 82.19] per 100, 000), while the lowest ASDR was in Japan (19.10 [95% UI: 15.10 to 23.82] per 100,000). Notably, all these countries significantly declined the ASDR of OA-IBD from 1990 to 2021. The fastest decline was in the Republic of Korea (AAPC: −3.72 [95% CI: −3.86 to − 3.59], P < .001), and the slowest was in the Mongolia (AAPC: −0.67 [95% UI: −0.92 to − 0.42], P < .001) (Table 1 and Fig. 1D). Detailed information on key change points for each country is provided in Figures S1 and 2, Supplemental Digital Content, https://links.lww.com/MD/P969.

Table 1.

The prevalence, DALYs, age-standardized rates, and their temporal trends of OA-IBD in 1990 and 2021.

Location Measure Cases (n), 1990 ASR (per 100,000 Population), 1990 Cases (n), 2021 ASR (per 100,000 Population), 2021 AAPC, 1990–2021 P-value
China Prevalence 10,369 (7905–13,322) 10.21 (7.78–13.16) 47,114 (36,367–60,026) 17.38 (13.42–22.16) 1.75 (1.61–1.89) <.001
Japan Prevalence 14,039 (11,212–17,498) 64.25 (51.27–80.08) 30,603 (24,326–38,203) 69.86 (56.03–86.82) 0.29 (0.19–0.39) <.001
Mongolia Prevalence 91 (69–119) 73.73 (55.64–97.01) 187 (144–241) 71.96 (55.17–93.27) −0.07 (−0.13 to −0.01) .023
Republic of Korea Prevalence 2484 (1960–3092) 72.59 (57.01–90.84) 15,282 (12,122–19,045) 121.29 (96.07–151.35) 1.7 (1.6–1.79) <.001
Democratic People’s Republic of Korea Prevalence 184 (137–244) 9.77 (7.23–13.02) 386 (290–513) 9.58 (7.18–12.75) −0.06 (−0.08 to −0.04) <.001
China DALYs 49,170 (29,548–64,411) 67.14 (39.06–88.55) 79,120 (59,996–109,284) 33.16 (25.09–46.37) −2.25 (−2.43 to −2.07) <.001
Japan DALYs 5864 (4933–6839) 28.9 (24.21–33.56) 9536 (7558–11,698) 19.1 (15.1–23.82) −1.22 (−1.79 to −0.64) <.001
Mongolia DALYs 61 (37–95) 50.49 (30.15–79.82) 101 (62–154) 41.8 (25.02–64.85) −0.67 (−0.92 to −0.42) <.001
Republic of Korea DALYs 3183 (1593–4762) 130.79 (59.46–202.61) 4878 (3106–8084) 40.39 (25.55–67.94) −3.72 (−3.86 to −3.59) <.001
Democratic People’s Republic of Korea DALYs 806 (405–1465) 56.71 (28.29–104.4) 1636 (842–2937) 45.3 (23.09–82.19) −0.73 (−0.82 to −0.64) <.001
Open in a new tab

AAPC = average annual percent change, ASR = age-standardized rates, DALYs = disability-adjusted life years, OA-IBD = older adults with inflammatory bowel disease.

Figure 1.

Figure 1.

Open in a new tab

The burden and temporal trends of OA-IBD stratified between 1990 and 2021. (A) The burden of OA-IBD in 1990; (B) the burden of OA-IBD in 2021; (C) the temporal trend of ASPR for OA-IBD; (D) the temporal trend of ASDR for OA-IBD. ASDR = Age-standardized disability-adjusted life years rate, ASPR = age-standardized prevalence rate, DRPK = Democratic People’s Republic of Korea, OA-IBD = older adults with Inflammatory bowel disease.

3.2. Gender and age differences in the burden of OA-IBD

The number of OA-IBD cases increased from 1990 to 2021 in both males (from 12,248 to 44,784) and females (from 14,848 to 48,624) in East Asia (Table 2 and Fig. 2). In most countries, the ASPR is higher among males than females, with China being an exception. Compared with females, males experienced a more rapid increase in China (AAPC: 1.80 vs 1.71), and Republic of Korea (AAPC: 1.84 vs 1.48). Conversely, in Japan, females exhibited a faster growth rate than their male counterparts (AAPC: 0.30 vs 0.25). However, both genders saw a decline in ASPR within Mongolia (P < .001); similarly, a decrease was noted for females in the DPRK (AAPC: −0.10 [95%CI: −0.14 to − 0.07], P < .001). Meanwhile, the DALYs number of OA-IBD increased from 1990 to 2021 in both males (from 25,747 to 52,028) and females (from 33,337 to 43,243) (Table 2). Despite this rise in DALYs numbers across all East Asian nations, there was a significant reduction in ASDR for both genders, with women experiencing a more rapid decline. Figure 2 further highlights the age-related burden of OA-IBD. The prevalence number peaked in the 60-to-64 age group and gradually declined with advancing age. In contrast with prevalence trends, DALY number initially escalate with advancing age, reaching their peak among individuals aged 70 to 75 years before gradually decreasing thereafter. Figure 2 provides the proportion of OA-IBD in different countries in East Asia as a whole. We can observe significant differences in geographic distribution. Specifically, in 1990, Japan dominated the prevalence of IBD in East Asia. By 2021, China’s prevalence has increased significantly, becoming the leading country in the region. Meanwhile, in terms of DALY, China has maintained a high proportion throughout the period.

Table 2.

The burden of OA-IBD stratified by sex in East Asia.

Location Sex Cases of Prevalence, 1990 ASPR (per 100,000 Population), 1990 Cases of Prevalence, 2021 ASPR (per 100,000 Population), 2021 AAPC,1990–2021 P-value Number of DALYs, 1990 ASDR (per 100,000 Population), 1990 Number of DALYs, 2021 ASDR (per 100,000 Population), 2021 AAPC, 1990–2021 P-value
China Female 5569 (4253–7149) 10.52 (8.03–13.54) 24,824 (19,242–31,470) 17.67 (13.7–22.41) 1.71 (1.55–1.86) <.001 27,477 (12,866–38,374) 66.77 (30.64–93.54) 35,26 (22,880–60,512) 26.65 (17.27–45.83) −2.94 (−3.14–−2.75) <.001
Male 4799 (3638–6195) 9.86 (7.48–12.8) 22,290 (17,067–28,635) 17.06 (13.07–21.95) 1.8 (1.69–1.91) <.001 21,693 (13,461–29,471) 68.43 (41.9–93.23) 43,859 (32,407–63,021) 42.56 (31.55–61.31) −1.51 (−1.74–−1.28) <.001
Japan Female 7685 (6136–9548) 61.42 (49.05–76.3) 16,098 (12,805 to 20,100) 66.99 (53.79–83.08) 0.3 (0.18–0.42) <.001 3282 (2688–3855) 27.05 (22.03–31.77) 4351 (3231–5552) 15.08 (11.13–19.7) –1.77 (–2.21 to −1.32) <.001
Male 6354 (5062–8053) 68.2 (54.22–86.55) 14,505 (11,463 to 18,410) 73.25 (58.31–92.56) 0.25 (0.14–0.35) <.001 2582 (2210–3016) 31.51 (27.12–36.33) 5185 (4291–6213) 24.05 (19.73–29.21) –0.8 (−1.3 to −0.3) .002
Mongolia Female 50 (38–66) 73.13 (55.47–96.45) 108 (83–139) 71.04 (54.13–92.05) −0.09 (−0.19 to 0.01) .084 29 (16–52) 43.35 (23.63–77.37) 47 (26–85) 34.05 (18.12–61.9) −0.86 (−1.14 to −0.58) <.001
Male 41 (30–54) 74.36 (55.08–99.54) 78 (59–103) 73.27 (54.63–96.91) −0.04 (−0.06 to −0.02) <.001 31 (16–59) 59.52 (29.12–112.64) 54 (27–99) 52.92 (26.09–99.71) −0.42 (−0.6–−0.23) <.001
Republic of Korea Female 1429 (1137–1796) 69.24 (54.78–87.43) 7370 (5805–9329) 108.27 (85.34–136.86) 1.48 (1.33–1.64) <.001 2013 (784–3401) 127.17 (46.32–218.15) 2547 (1371–5267) 35.9 (19.46–73.11) −4.07 (−4.39 to −3.74) <.001
Male 1054 (809–1395) 78.57 (59.81–104.13) 7911 (6158–9976) 137.43 (106.42–174.27) 1.84 (1.74–1.93) <.001 1170 (537–1812) 135.35 (53.95–214.28) 2331 (1436–3816) 45.66 (28.21–76.89) −3.43 (−3.59 to −3.27) <.001
Democratic People’s Republic of Korea Female 115 (84–153) 9.6 (7.02–12.82) 224 (166–297) 9.29 (6.91–12.32) −0.1 (−0.14 to −0.07) <.001 536 (213–1156) 55.94 (22.1–120.56) 1037 (418–2238) 43.38 (17.52–93.1) −0.82 (−0.97 to −0.66) <.001
Male 69 (50–92) 10.09 (7.35–13.58) 163 (120–218) 10.02 (7.34–13.5) −0.02 (−0.05 to 0.01) .221 271 (127–504) 57.52 (26.6–107.38) 599 (242–1234) 48.27 (19.48–98.55) −0.56 (−0.61 to −0.52) <.001
Open in a new tab

AAPC = average annual percent change, ASDR = age-standardized disability-adjusted life years rate, ASPR = age-standardized prevalence rate.

Figure 2.

Figure 2.

Open in a new tab

The burden of OA-IBD stratified by age and sex in 1990 and 2021 in East Asia. (A) The prevalence cases of OA-IBD stratified by age and sex in East Asia; (B) The DALYs number of OA-IBD stratified by age and sex in East Asia. DALYs = disability-adjusted life years, DRPK = Democratic People’s Republic of Korea, OA-IBD = older adults with inflammatory bowel disease.

3.3. Decomposition analysis of OA-IBD burden

Figure 3 demonstrates the influence of population aging, population growth, and epidemiological changes on the disparities in OA-IBD burden across countries. From 1990 to 2021, the changing trend in OA-IBD was most evident in China, with the overall burden (including prevalence and DALYs) difference being 36,745 and 29,950, respectively (Table S1, Supplemental Digital Content, https://links.lww.com/MD/P970). The changing trend of OA-IBD in Mongolia was least evident, with the difference of prevalence and DALYs being 96.1 and 40.01, respectively. Based on the results of the decomposition analysis, both the burden of prevalence and DALYs were mainly driven by population growth (Fig. 3 and Table S1, Supplemental Digital Content, https://links.lww.com/MD/P970). The region most affected by population growth is DPRK, at 106.19%. The country with the largest contribution to DALYs due to population growth is Republic of Korea, at 385.04%.

Figure 3.

Figure 3.

Open in a new tab

Decomposition analysis of burden for OA-IBD from 1990 to 2021. (A) The decomposition analysis of prevalence for OA-IBD from 1990 to 2021. (B) The decomposition analysis of DALYs for OA-IBD from 1990 to 2021. DALYs = disability-adjusted life years, OA-IBD = older adults with inflammatory bowel disease.

3.4. The impact of economic development on OA-IBD burden

Figure 4 shows the correlation between OA-IBD burden and SDI from 1990 to 2021. There is a positive correlation between the ASPR and SDI (R = 0.684, P < .001) (Fig. 4A). On the other hand, there was a negative correlation between the ASDR and SDI (r = −0.201, P < .05), and the ASDR of OA-IBD rapidly decreased with the increase of SDI in all 5 countries (Fig. 4B).

Figure 4.

Figure 4.

Open in a new tab

The impact of economic development on OA-IBD burden. (A) Correlation analysis between SDI and ASPR of OA-IBD; (B) correlation analysis between SDI and ASDR of OA-IBD. ASDR = age-standardized disability-adjusted life years rate, ASPR = age-standardized prevalence rate, SDI = socio-demographic index, OA-IBD = older adults with Inflammatory bowel disease

4. Discussion

This study provides the first comprehensive analysis of the burden of OA-IBD in East Asia. Overall, the disease burden of OA-IBD is rapidly increasing, aligning with overall global burden of IBD trends.[16] The results of decomposition analysis show that the growing burden of OA-IBD has been largely attributed to population growth over the past 30 years. Additionally, we observed that the SDI significantly impacted changes in disease burden, exhibiting a positive correlation with prevalence of OA-IBD and a negative correlation with DALYs. These findings collectively highlight that OA-IBD has become a critical public health challenge in East Asia,

East Asian countries have experienced rapid industrialization and urbanization over the past 3 decades, resulting in profound societal and environmental transformations.[17] On the one hand, industrialization, characterized by the discharge of industrial wastewater and exhaust gases, has increased population exposure to environmental pollutants, a known risk factor of IBD.[18,19] On the other hand, the widespread adoption of the Western dietary pattern in East Asia has significantly increased the consumption of foods rich in fat, sugar, and fiber.[20] These dietary components are also believed to be closely linked to the pathogenesis of IBD.[21,22] At the same time, the aging problem in East Asia continues to worsen, with the proportion of the elderly population steadily increasing. This demographic shift, coupled with environmental changes, dietary transitions, and lifestyle modifications, has collectively accelerated the burden of OA-IBD in the region. In addition, a Danish cohort study showed that the use of antibiotics is associated with an increased risk of IBD, especially those affecting the gastrointestinal microbiome, with this association being especially prominent in middle-aged and elderly populations. Due to the different stages of industrialization of countries in East Asia, development trends of OA-IBD in the region are highly heterogeneous. As a result, developed countries like Japan are experiencing a gradual slowdown in growth, while China continues to sustain a robust and high growth rate. Compared with younger patients with IBD, older patients with IBD face significantly greater challenges. For example, Elderly IBD often leads to delayed diagnosis due to its atypical symptoms, with the average delay in diagnosis for older IBD patients being about 16 months, compared to just 5 months for younger people.[23] It is encouraging to observe that, despite an overall increase in DALYs, ASDRs have declined significantly in all countries from 1990 to 2021. This indicates substantial progress in the treatment and management of IBD, which may be attributed to the widespread use of biologics. The use of biologics has markedly improved outcomes by reducing severe complications and disability associated with IBD.[24] Khoudari et al reported that biologics could reduce surgery rates for IBD based on a retrospective population-based cohort study.[25] Similarly, another study highlighted that early initiation of biologics significantly reduces the risk of colectomy in patients with CD.[26]

In the Asia-Pacific region, the incidence of IBD is higher in males than in females.[27] Our result found the same trend in prevalence and DALYs burden of IBD in most countries. This gender difference may be influenced by several aspects.[28–30] Firstly, the high level of estrogen may exert a protective effect against the development of IBD, as previous studies have shown that sex hormones not only affect intestinal barrier function and mucosal immune activation but may also play a potential role in regulating the gut microbiome.[28,31] To be specific, estrogen enhances intestinal epithelial barrier integrity by upregulating tight junction proteins (e.g., occludin, and ZO-1) and modulating mucus production, thereby reducing epithelial permeability and oxidative damage.[32,33] At lower concentrations, estrogen may promote the differentiation of Th1 and Th17 cells, enhancing the expression of pro-inflammatory cytokines such as IFN-γ[34]; at higher concentrations, however, estrogen tends to enhance Th2-type immune responses and the activity of Tregs, thereby exerting anti-inflammatory effects.[35] In terms of influencing gut microbiota, estrogen exerts anti-inflammatory and protective effects by suppressing the overgrowth of pathogenic bacteria (such as Escherichia coli and Bacteroides fragilis) and promoting the proliferation of beneficial bacteria (such as Bifidobacterium), thereby maintaining gut microbial balance.[36] In contrast, androgen may disrupt gut microbiota homeostasis by altering the Firmicutes/Bacteroidetes ratio, thereby weakening its anti-inflammatory function.[37] In terms of lifestyle factors, males tend to show higher smoking rates and lower intake of fruits and vegetables, both of which are associated with a higher risk of IBD.[30,38] However, in China, the prevalence of IBD in elderly females is higher than that in males. This is consistent with previously reported global trends and contradicts the results reported for the Asia-Pacific region.[27,39] The specific causes are unclear but it may have to do with women being more prone to psychological problems, which may worsen the symptoms and burden of IBD. In terms of age, since IBD mainly occurs in young adults, we found a decreasing trend in the prevalence rate of OA-IBD with increasing age. In contrast, the DALYs of OA-IBD first increase and then decrease with age. Compared to younger patients, OA-IBD is more susceptible to adverse events with immunosuppressive therapies. For example, OA-IBD is more prone to osteoporosis when glucocorticoids are used.[40] In addition, due to the weakened immune capacity of older people, OA-IBD is more susceptible to serious infection risks when using biologics.[41] Therefore, given these situations, we need to strengthen the comprehensive management of OA-IBD.

In addition to describing the temporal trend of OA-IBD, we also investigated the potential influencing factors contributing to its burden. The results of the decomposition analysis reveal that population growth was the primary driver behind the increased burden. This phenomenon may be attributed to population growth after World War II, especially the baby boom of the 1960s. People born during this period will be around 60 years old in 2021, becoming the main group of OA-IBD.[42] Although fertility is currently declining in East Asia, the impact on the burden of OA-IBD will take decades to change. As previously described, the impact of epidemiological changes on the prevalence of OA-IBD varies depending on the stage of industrialization. In emerging countries, the impact of epidemiological changes will further increase the burden of OA-IBD. Furthermore, the variation in OA-IBD burden across different SDI quantiles shows that the imbalance of economic development impacts the distribution of medical and health resources. In recent years, the Chinese government has made efforts to improve primary health care and health security systems and has expanded the service capacity for patients with IBD.[43] In Japan and Republic of Korea, medical care for IBD patients can be guaranteed due to the high of public health insurance.[44] From 2020 to 2050, East Asia’s population will continue to increase and aging will worsen.[7] Consequently, the burden of OA-IBD is expected to increase continually in East Asia in the foreseeable future. To address this challenge, countries should implement tailored measures based on their specific circumstances. In high-burden nations such as Japan and China, it is essential to strengthen control over risk factors and implement early screening programs. In resource-limited settings like Mongolia and North Korea, efforts should focus on enhancing diagnostic capabilities. This includes investing in medical infrastructure, training healthcare professionals, and improving access to essential diagnostic tools to ensure accurate and timely diagnosis of IBD. Furthermore, establishing a transnational East Asian collaboration network could be highly beneficial. By sharing data, launching joint research initiatives, and developing regional guidelines for IBD management, this network can help alleviate the disease burden in the region.

Overall, this study describes the burden of OA-IBD in East Asia and provides valuable information for a better understanding of the epidemiological characteristics of the region. Additionally, we explored the underlying drivers of this burden, which enhances our understanding of the disease’s development patterns and trends. However, there are certain limitations to this study. First of all, the data is the result of the model estimation after collecting the original data, which may have a certain deviation from the actual situation, particularly in countries with limited monitoring capacity like Mongolia and North Korea. Secondly, the GBD 2021 lacks specific information on UC or CD subtypes and the participants’ age at disease onset, making further analysis unfeasible. Moreover, although the decomposition analysis in this study considered 3 primary factors, the examination of epidemiological changes remains relatively broad. Given the potential significant impact of cross-country differences in cultural contexts, industrialization patterns, environmental factors (e.g., air pollution and dietary habits), and socio-economic disparities on the study results. Future studies should focus on a comprehensive understanding of the specific epidemiological characteristics and drivers of OA-IBD to provide a scientific basis for intervention strategies. On the one hand, prospective multicenter cohorts across East Asia should be prioritized to define region-specific incidence, prevalence trends, and geographic variations of elderly-onset IBD (≥60 years). On the other hand, researchers should integrate Comprehensive Geriatric Assessment to quantify the impact of frailty, nutrition, and cognitive function on IBD outcomes.

5. Conclusion

In conclusion, the growing burden of OA-IBD in East Asia calls for a comprehensive and coordinated response. To effectively reduce the disease burden of OA-IBD and improve patient health outcomes across the region, countries must provide financial support, optimize the allocation of health care resources, and strengthen international cooperation.

Acknowledgments

We thank the collaborators of the Global Burden of Disease Study 2021 for their work. We thank all the individuals who contributed to the GBD 2021 for their extensive support in finding, cataloging, and analyzing data and facilitating communications.

Author contributions

Conceptualization: Jiang Liu.

Methodology: Qingbo Yan.

Project administration: Jiang Liu.

Resources: Jiang Liu.

Software: Qingbo Yan, Yiyong Chen.

Supervision: Jiang Liu.

Validation: Qingbo Yan.

Visualization: Qingbo Yan.

Writing – original draft: Qingbo Yan.

Writing – review & editing: Yiyong Chen, Huayu Zhang, Wenping Liu, Jiang Liu.

Supplementary Material

medi-104-e44580-s001.docx (571.7KB, docx)
medi-104-e44580-s002.docx (17.6KB, docx)

Abbreviations:

AAPCs
average annual percentage changes
ASDR
age-standardized disability-adjusted life years rate
ASPR
age-standardized prevalence rate
GBD
global burden of diseases
GHDx
global health data exchange
ICD
International Classification of Diseases
OA-IBD
older adults with Inflammatory bowel disease
SDI
socio-demographic index
UIs
uncertainty intervals

All authors have read and agreed to the published version of the manuscript.

This study was reanalyzed using published GBD 2021 data. We did not collect raw data on this manuscript and therefore no separate ethical approval was required for this study.

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are publicly available.

Supplemental Digital Content is available for this article.

How to cite this article: Yan Q, Chen Y, Zhang H, Liu W, Liu J. The rising burden of inflammatory bowel disease in East Asia’s aging population: A cross-sectional study. Medicine 2025;104:37(e44580).

For commercial use and modifications please contact the corresponding author.

Contributor Information

Qingbo Yan, Email: 617762961@qq.com.

Yiyong Chen, Email: 870369936@qq.com.

Huayu Zhang, Email: zhy9916@sohu.com.

Wenping Liu, Email: 13850559982@163.com.

References

  • [1].Singh S, Boland BS, Jess T, Moore AA. Management of inflammatory bowel diseases in older adults. Lancet Gastroenterol Hepatol. 2023;8:368–82. [DOI] [PubMed] [Google Scholar]
  • [2].Singh S, Picardo S, Seow CH. Management of inflammatory bowel diseases in special populations: obese, old, or obstetric. Clin Gastroenterol Hepatol. 2020;18:1367–80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [3].Ananthakrishnan AN, Shi HY, Tang W, et al. Systematic review and meta-analysis: phenotype and clinical outcomes of older-onset inflammatory bowel disease. J Crohns Colitis. 2016;10:1224–36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [4].Jayasooriya N, Baillie S, Blackwell J, et al. ; POP-IBD study group. Systematic review with meta-analysis: time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease. Aliment Pharmacol Ther. 2023;57:635–52. [DOI] [PubMed] [Google Scholar]
  • [5].Qian AS, Nguyen NH, Elia J, Ohno-Machado L, Sandborn WJ, Singh S. Frailty is independently associated with mortality and readmission in hospitalized patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol. 2021;19:2054–63.e14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [6].Bureau PR. Countries with the oldest populations in the world. https://www.prb.org/countries-with-the-oldest-populations/. Accessed February 13, 2025.
  • [7].Gu D, Andreev K, Dupre ME. Major trends in population growth around the world. China CDC Wkly. 2021;3:604–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [8].Gu WJ, Ning FL, Jin HR, et al. Burden and trends of IBD in 5 Asian Countries from 1990 to 2019: a comparison with the United States and the United Kingdom. Dis Colon Rectum. 2023;66:567–78. [DOI] [PubMed] [Google Scholar]
  • [9].Wang X, Xiu R, Gong L, et al. Unraveling the global burden of inflammatory bowel disease (1990-2019): a joinpoint regression analysis of divergent trends in 10-24 and 50-69 age cohorts. Autoimmun Rev. 2024;23:103586. [DOI] [PubMed] [Google Scholar]
  • [10].GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:2100–32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [11].GBD 2017 Mortality Collaborators. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1684–735. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [12].Organization WH. Definition of an older or elderly person. https://www.who.int/health-topics/ageing#tab=tab_1. Accessed February 13, 2025.
  • [13].Rozich JJ, Luo J, Dulai PS, et al. Disease- and treatment-related complications in older patients with inflammatory bowel diseases: comparison of adult-onset vs elderly-onset disease. Inflamm Bowel Dis. 2021;27:1215–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [14].Wang S, Dong Z, Wan X. Global, regional, and national burden of inflammatory bowel disease and its associated anemia, 1990 to 2019 and predictions to 2050: an analysis of the global burden of disease study 2019. Autoimmun Rev. 2023;23:103498. [DOI] [PubMed] [Google Scholar]
  • [15].Cheng X, Yang Y, Schwebel DC, et al. Population ageing and mortality during 1990-2017: a global decomposition analysis. PLoS Med. 2020;17:e1003138. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [16].Danpanichkul P, Suparan K, Arayakarnkul S, et al. Global epidemiology and burden of elderly-onset inflammatory bowel disease: a decade in review. J Clin Med. 2023;12:5142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [17].Cui G, Liu H, Xu G, Laugsand JB, Pang Z. Exploring links between industrialization, urbanization, and chinese inflammatory bowel disease. Front Med (Lausanne). 2021;8:757025. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [18].Suarez RG, Osornio-Vargas AR, Wine E. Ambient air pollution and pediatric inflammatory bowel diseases: an updated scoping review. Dig Dis Sci. 2022;67:4342–54. [DOI] [PubMed] [Google Scholar]
  • [19].Chen X, Wang S, Mao X, et al. Adverse health effects of emerging contaminants on inflammatory bowel disease. Front Public Health. 2023;11:1140786. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [20].Huang L, Wang Z, Wang H, et al. Nutrition transition and related health challenges over decades in China. Eur J Clin Nutr. 2021;75:247–52. [DOI] [PubMed] [Google Scholar]
  • [21].Trakman GL, Lin WYY, Hamilton AL, et al. Processed food as a risk factor for the development and perpetuation of crohn’s disease-the ENIGMA study. Nutrients. 2022;14:3627. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [22].Fu T, Chen H, Chen X, et al. Sugar-sweetened beverages, artificially sweetened beverages and natural juices and risk of inflammatory bowel disease: a cohort study of 121,490 participants. Aliment Pharmacol Ther. 2022;56:1018–29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [23].Cross E, Saunders B, Farmer AD, Prior JA. Diagnostic delay in adult inflammatory bowel disease: a systematic review. Indian J Gastroenterol. 2023;42:40–52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [24].Zhao M, Sall Jensen M, Knudsen T, et al. Trends in the use of biologicals and their treatment outcomes among patients with inflammatory bowel diseases - a Danish nationwide cohort study. Aliment Pharmacol Ther. 2022;55:541–57. [DOI] [PubMed] [Google Scholar]
  • [25].Khoudari G, Mansoor E, Click B, et al. Rates of intestinal resection and colectomy in inflammatory bowel disease patients after initiation of biologics: a Cohort study. Clin Gastroenterol Hepatol. 2022;20:e974–83. [DOI] [PubMed] [Google Scholar]
  • [26].Lujan R, Buchuk R, Focht G, et al. Early initiation of biologics and disease outcomes in adults and children with inflammatory bowel diseases: results from the epidemiology group of the nationwide Israeli inflammatory bowel disease research nucleus cohort. Gastroenterology. 2024;166:815–25.e22. [DOI] [PubMed] [Google Scholar]
  • [27].Shah SC, Khalili H, Chen CY, et al. Sex-based differences in the incidence of inflammatory bowel diseases-pooled analysis of population-based studies from the Asia-Pacific region. Aliment Pharmacol Ther. 2019;49:904–11. [DOI] [PubMed] [Google Scholar]
  • [28].De Simone V, Matteoli G. Estrogen-mediated effects underlie gender bias in inflammatory bowel disease. Cell Mol Gastroenterol Hepatol. 2018;5:638–9.e1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [29].Sun Y, Yuan S, Chen X, et al. The contribution of genetic risk and lifestyle factors in the development of adult-onset inflammatory bowel disease: a prospective cohort study. Am J Gastroenterol. 2023;118:511–22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [30].Ng M, Freeman MK, Fleming TD, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014;311:183–92. [DOI] [PubMed] [Google Scholar]
  • [31].Xu L, Huang G, Cong Y, Yu Y, Li Y. Sex-related differences in inflammatory bowel diseases: the potential role of sex hormones. Inflamm Bowel Dis. 2022;28:1766–75. [DOI] [PubMed] [Google Scholar]
  • [32].van der Giessen J, van der Woude CJ, Peppelenbosch MP, Fuhler GM. A direct effect of sex hormones on epithelial barrier function in inflammatory bowel disease models. Cells. 2019;8:261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [33].Diebel ME, Diebel LN, Manke CW, Liberati DM. Estrogen modulates intestinal mucus physiochemical properties and protects against oxidant injury. J Trauma Acute Care Surg. 2015;78:94–9. [DOI] [PubMed] [Google Scholar]
  • [34].Chen RY, Fan YM, Zhang Q, et al. Estradiol inhibits Th17 cell differentiation through inhibition of RORgammaT transcription by recruiting the ERalpha/REA complex to estrogen response elements of the RORgammaT promoter. J Immunol. 2015;194:4019–28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [35].Namazi MR. The Th1-promoting effects of dehydroepiandrosterone can provide an explanation for the stronger Th1-immune response of women. Iran J Allergy Asthma Immunol. 2009;8:65–9. [PubMed] [Google Scholar]
  • [36].Yang Y, Qu C, Liang S, et al. Estrogen inhibits the overgrowth of Escherichia coli in the rat intestine under simulated microgravity. Mol Med Rep. 2018;17:2313–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [37].Harada N, Hanaoka R, Horiuchi H, et al. Castration influences intestinal microflora and induces abdominal obesity in high-fat diet-fed mice. Sci Rep. 2016;6:23001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [38].Saracino IM, Spisni E, Imbesi V, et al. The bidirectional link between nutritional factors and inflammatory bowel diseases: dietary deficits, habits, and recommended interventions-a narrative review. Foods. 2023;12:1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [39].GBD 2017 Inflammatory Bowel Disease Collaborators. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5:17–30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [40].Govani SM, Wiitala WL, Stidham RW, et al. Age disparities in the use of steroid-sparing therapy for inflammatory bowel disease. Inflamm Bowel Dis. 2016;22:1923–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [41].Borren NZ, Ananthakrishnan AN. Safety of biologic therapy in older patients with immune-mediated diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019;17:1736–43.e4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [42].GBD 2017 Population and Fertility Collaborators. Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1995–2051. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [43].Chen X, Giles J, Yao Y, et al. The path to healthy ageing in China: a Peking University-Lancet Commission. Lancet. 2022;400:1967–2006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [44].Wei SC. Differences in the public medical insurance systems for inflammatory bowel disease treatment in Asian countries. Intest Res. 2016;14:218–23. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

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

Supplementary Materials

medi-104-e44580-s001.docx (571.7KB, docx)
medi-104-e44580-s002.docx (17.6KB, docx)

Articles from Medicine are provided here courtesy of Wolters Kluwer Health

RESOURCES