Trends and burden of inflammatory bowel disease in children (aged 0–14 years) in Asia and Europe, 1990–2021: a global burden of disease 2021 analysis

Abstract

Background

Inflammatory bowel disease (IBD), including Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U), is a chronic immune-mediated gastrointestinal disorder. We analyzed the burden and epidemiological trends of IBD in children aged 0–14 years across Asia and Europe from 1990 to 2021, using the Global Burden of Disease (GBD) 2021 study data.

Methods

We extracted IBD data from the GBD 2021 database, which offers comprehensive estimates for diseases and risk factors across 204 countries and territories. Our analysis focused on prevalence, incidence, mortality, and disability-adjusted life-years (DALYs), emphasizing modifiable risk factors. We applied advanced statistical methods, including estimated annual percentage change (EAPC) to quantify trends, decomposition analysis to assess contributing factors, and Bayesian age–period–cohort (BAPC) modeling to evaluate temporal and demographic effects. ARIMA modeling forecasted future trends.

Results

From 1990 to 2021, IBD incidence, prevalence, and DALYs increased significantly in Asia but declined in Europe. In East Asia, prevalence rose from 1,265.78 cases (95% UI: 921.46–1,672.24) in 1990 to 1,402.33 cases (95% UI: 1,043.79–1,825.73) in 2021, while high-income Asian regions saw a decrease. ARIMA forecasts predict a continued rise in Asia’s incidence over the next decade, with DALYs expected to decline. In Europe, incidence is projected to stabilize, and DALYs are anticipated to decrease.

Conclusion

The rising IBD burden in Asian children may be associated with rapid socioeconomic development, lifestyle westernization, and environmental influences, as suggested by prior epidemiologic and mechanistic studies. These findings underscore the need for targeted public health strategies to curb Asia’s increasing incidence and optimize disease management in Europe.

Introduction

Inflammatory bowel disease (IBD), an immune-mediated chronic inflammatory disorder affecting the gastrointestinal tract, encompasses Crohn’s disease [1,2], ulcerative colitis, and IBD-unclassified. Approximately 20–30% of patients receive their diagnosis during childhood or adolescence. Globally, the incidence of pediatric IBD is on the rise, not only in traditionally high-incidence regions like Western Europe and North America but also in newly industrialized countries across Asia, Africa, and South America. Incidence rates in Asia range from 0.5 to 21.6 per 100,000 person-years [3,4]. The long-term prognosis of IBD includes an increased risk of comorbidities and reduced quality of life, further underscoring the importance of understanding its epidemiological characteristics [5].

Previous studies on IBD incidence and mortality have largely relied on hospital databases [6]. However, epidemiological statistics have been challenging due to difficulties in data collection and preservation, with missing data from outpatient visits being a common issue. Furthermore, IBD pathogenesis involves a complex interplay of genetic predisposition, environmental factors, gut microbiota, aberrant immune responses, and potentially other risk factors. IBD diagnosis primarily relies on clinical, endoscopic, histologic, and imaging assessments, while genetic testing is reserved for monogenic or VEOIBD cases. Resulting in significantly higher diagnosis rates in economically developed countries or regions compared to their less developed counterparts [7].

This study focuses on children aged 0–14 years. This age range was selected based on the WHO’s definition of childhood (0–18 years), but with consideration for variations in national legal definitions of childhood across countries [8]. For instance, China and India define childhood as ending at 14 years of age [9]. To ensure rigor in data collection, we have adopted the 0–14 years age bracket.

In terms of geographical focus, Europe and Asia present both similarities and differences in the epidemiology and clinical management of pediatric IBD, warranting further comparative analysis [10]. Disease surveillance in both regions relies on registration networks, yet there are substantial disparities in network coverage and infrastructure development. Europe, as a high-incidence region for IBD, benefits from well-established national registry systems that ensure standardized disease definitions, improved diagnostic accuracy, and reduced risk of misclassification bias from an epidemiological perspective. These registries facilitate consistent surveillance rather than direct disease control. In contrast, Asia has experienced rapid socioeconomic and healthcare development, leading to the gradual establishment of pediatric IBD registry or surveillance networks. This improved diagnostic capacity may partly explain the observed increase in reported incidence; however, true epidemiological shifts related to lifestyle westernization, antibiotic exposure, and environmental change may also contribute [11]. Furthermore, notable differences exist between these continents in dietary habits, childhood antibiotic use patterns, and healthcare policies. By selecting Europe and Asia for comparative analysis, this study aims to explore the relationships between pediatric IBD epidemiology and societal development, economic status, and healthcare conditions [12].

Leveraging the latest GBD 2021 dataset and employing advanced statistical methodologies, this research evaluates temporal trends, quantifies the relative contributions of demographic factors, and provides a forward-looking perspective on the IBD burden within this age group. This study addresses a significant gap in the existing literature, particularly concerning the relative dearth of research focusing on IBD in children aged 0–14 years. While previous studies have primarily examined disease burden at the national or regional level globally, comparative analyses specifically between Asia and Europe remain scarce.

This research offers the most current and comprehensive epidemiological analysis of pediatric IBD across both continents, providing a scientific foundation for policy formulation, resource allocation, and public health strategies. This study provides updated evidence to guide pediatric IBD surveillance and public health decision-making.

Methods

Data collection and download

Data for pediatric and adolescent inflammatory bowel disease utilized in this study were sourced from the GBD 2021 database. This database provides the latest estimates for 369 diseases, injuries, impairments, and 88 risk factors, encompassing 204 countries and territories categorized into 21 regions. This regional classification system is widely employed in GBD studies and has demonstrated effectiveness in facilitating geographical and epidemiological comparisons. Our analysis also examined disease burden disparities across 93 countries and territories in Asia and Europe, offering a detailed examination of pediatric IBD trends within these continents. Direct comparisons between nations and regions have been conducted to derive more intuitive conclusions, identify epidemiological variations across different countries and regions, and analyze their underlying causes. This approach aims to enhance our understanding of the disparities in pediatric IBD disease burden across diverse national and regional contexts within Asia and Europe.

In this study, we extracted data pertinent to pediatric IBD, encompassing incidence, mortality, and disability-adjusted life years (DALYs). These metrics are accompanied by 95% uncertainty intervals (UI) to provide a measure of statistical confidence. The calculation of DALYs integrates years of life lost (YLLs) and years lived with disability (YLDs), thereby offering a comprehensive reflection of disease burden.

To contextualize our findings, we employed the socio-demographic Index (SDI), a composite indicator assessing regional development levels based on income, education, and fertility rates. GBD 2021 categorizes countries and territories into five SDI quintiles, ranging from low to high development. All data utilized in this study are publicly accessible via the following URL: http://ghdx.healthdata.org/gbd-results-tool. Data analysis was completed on January 30, 2025. The Institutional Review Board of Shuguang Hospital affiliated with Shanghai University of Traditional Chinese Medicine deemed formal ethical approval unnecessary for this study, as it exclusively utilizes publicly available data. All methodologies adhere to relevant guidelines and regulations.

Methodological overview

The methodologies employed in the GBD 2021 study have been extensively elucidated in prior publications. The application of multiple statistical approaches (EAPC, BAPC, ARIMA, frontier and inequality analyses) was intended to provide complementary perspectives: EAPC quantified temporal change, BAPC captured age–period–cohort effects, ARIMA projected future incidence, and frontier/inequality analyses highlighted health system efficiency and equity. While simpler descriptive approaches could summarize overall burden, these advanced methods allowed us to triangulate evidence from different angles, enhancing robustness and policy relevance. In the present study, 95% UI were computed for each variable. All rates are reported per 100,000 population. All statistical tests were two-tailed, with statistical significance defined as p < 0.05. For clarity, we provide a brief methodological note: DALY frontier analysis was conducted using data envelopment analysis to estimate the lowest achievable burden at each SDI level, and inequality was quantified by concentration indices and slope indices.

SDI correlation analysis

Utilizing SDI as a composite indicator of regional development, we analyzed correlations between SDI and IBD incidence, prevalence, mortality, and DALYs. Scatter plots and trend lines were employed to visualize the relationship between SDI and IBD burden, with a particular focus on disparities between high-SDI and low-SDI regions.

Frontier analysis

This methodology was employed to evaluate unrealized health gains in IBD burden across countries and territories at varying development levels. Non-parametric data envelopment analysis (DEA) was utilized to construct a non-linear frontier representing the minimum achievable disease burden at a given development level. The distance between each country’s or region’s DALYs and this frontier was calculated to quantify unrealized health gains. In this study, this distance is referred to as the ‘effective difference,’ representing the deviation of a country’s observed age-standardized DALY rate from the theoretical frontier value predicted by its socio-demographic index (SDI). A smaller effective difference indicates greater efficiency in disease burden control relative to the development level.

Health inequality analysis

This analysis aimed to investigate disparities in health status across populations with differing socioeconomic status or development levels. In this study, age-standardized DALY rates were specifically analyzed to assess health inequalities across regions. The objective was to elucidate disparities in pediatric IBD-related health burden across diverse regions within Asia and Europe, with a particular focus on evaluating long-term trends in health inequality through comparative analysis of data from 1990 and 2021.

Autoregressive integrated moving average (ARIMA) model

This model was utilized to forecast IBD incidence and DALYs for children aged 0–14 years in Asia and Europe over the next decade (2022–2031). Leveraging historical data from 1990 to 2021, the ARIMA model fitted time series data for incidence and DALYs, generating projections for the subsequent decade. The model facilitated predictions regarding trends in pediatric IBD incidence and DALYs in Asia and Europe, with a specific focus on the anticipated rise in incidence in Asia contrasted with the projected stabilization in Europe.

Results

Overview of the global burden

Notable disparities exist in the prevalence, incidence, and DALYs of IBD among children aged 0–14 years across Asia and Europe. From 1990 to 2021, Asia demonstrated an overall upward trend in IBD burden. For instance, in East Asia, prevalence surged from 1,265.78 cases (95% UI: 921.46–1,672.24) in 1990 to 1,402.33 cases (95% UI: 1,043.79–1,825.73) in 2021, with the age-standardized prevalence rate (ASPR) escalating from 0.4 to 0.55 per 100,000 population. Analogous upward trajectories were observed in South Asia, Southeast Asia, Central Asia, and the Middle East, with South Asia exhibiting the most pronounced surge. Conversely, high-income Asian regions (e.g. Japan, South Korea, Singapore) witnessed a decline in prevalence, from 387.91 cases (95% UI: 303.54–482.97) in 1990 to 249.87 cases (95% UI: 195.63–312.78) in 2021, with ASPR remaining relatively stable (1.02 to 1.1 per 100,000 population). In stark contrast, Europe experienced a marked decrease in IBD prevalence within this age group during the same period.

Temporal trends in prevalence, incidence, mortality, and DALYs for IBD in Asia and Europe exhibited parallel patterns, with Asia generally demonstrating an increase and Europe a decrease over the study period (Tables 1–4).

Table 1.

Estimated age-specific prevalence of inflammatory bowel disease (IBD) by GBD regions of Asia and Europe, 1990–2021.

Location	Prevalence(95%UI)
	1990_Number	1990_ASR	1990_Number	1990_ASR	1990_EAPC
East Asia	1265.78 (921.46–1672.24)	0.4 (0.29–0.53)	1402.33 (1043.79–1825.73)	0.55 (0.41–0.72)	1.64 (0.93–2.36)
South Asia	2932.32 (2210.08–3733.08)	0.75 (0.57–0.96)	4335.58 (3253.21–5557.12)	0.87 (0.66–1.12)	0.6 (0.41–0.79)
Southeast Asia	621.86 (449.33–828.98)	0.38 (0.27–0.51)	671.48 (484.75–892.52)	0.41 (0.3–0.55)	0.21 (0.13–0.3)
High-income Asia Pacific	387.91 (303.54–482.97)	1.02 (0.79–1.27)	249.87 (195.63–312.78)	1.1 (0.86–1.37)	0.69 (−0.19–1.56)
Central Asia	218.88 (168.25–279.07)	0.99 (0.76–1.27)	261.24 (201.54–331.27)	1.1 (0.85–1.39)	0.18 (0.11–0.24)
North Africa and Middle East	1226.51 (950.53–1553.83)	0.97 (0.75–1.22)	1931.97 (1501.71–2418.65)	1.15 (0.89–1.44)	0.5 (0.38–0.63)
Eastern Europe	370.53 (282.42–469.44)	0.75 (0.57–0.95)	292.65 (224.29–369.58)	0.83 (0.64–1.05)	0.21 (0.14–0.28)
Western Europe	3199.1 (2626.37–3833.89)	4.41 (3.61–5.28)	2510.02 (1989.67–3156.05)	3.75 (2.97–4.72)	−1.08 (−1.57 to –0.59)
Central Europe	540.51 (430.48–665.04)	1.75 (1.39–2.15)	340.97 (270.72–422.07)	1.95 (1.55–2.42)	0.68 (0.26–1.11)

ASR = Age-standardized rate; EAPC = Estimated annual percentage change; UI = Uncertainty interval.

Table 2.

Estimated age-specific incidence of inflammatory bowel disease (IBD) by GBD regions of Asia and Europe, 1990–2021.

Location	Incidence(95%UI)
	1990_Number	1990_ASR	1990_Number	1990_ASR	1990_EAPC
East Asia	351.21 (255.56–473.83)	0.11 (0.08–0.15)	416.51 (308.91–547.49)	0.16 (0.12–0.21)	1.92 (1.16–2.68)
South Asia	913.81 (686.01–1193.09)	0.23 (0.18–0.31)	1332.08 (1009.2–1740.3)	0.27 (0.2–0.35)	0.58 (0.38–0.78)
Southeast Asia	170.98 (123.35–229.77)	0.11 (0.08–0.14)	194.17 (141.78–259.24)	0.12 (0.09–0.16)	0.39 (0.31–0.46)
High-income Asia Pacific	111.84 (86.54–141.24)	0.3 (0.23–0.38)	72.91 (55.98–93)	0.32 (0.25–0.41)	0.84 (−0.14 to –1.83)
Central Asia	65.14 (49.48–84.35)	0.29 (0.22–0.38)	80.28 (61.16–104.3)	0.33 (0.25–0.43)	0.29 (0.24–0.35)
North Africa and Middle East	377.06 (285.99–490.75)	0.3 (0.22–0.38)	598.65 (458.02–776.95)	0.36 (0.27–0.46)	0.5 (0.39–0.62)
Eastern Europe	109.43 (81.58–141.17)	0.22 (0.16–0.29)	88.26 (67.03–114.06)	0.25 (0.19–0.33)	0.3 (0.22–0.37)
Western Europe	1071.19 (872.47–1296.98)	1.49 (1.21–1.8)	829.13 (644.17–1055.65)	1.25 (0.97–1.59)	−1.11 (−1.63 to –0.6)
Central Europe	168.12 (131.48–210.1)	0.55 (0.43–0.69)	107.45 (83.09–136.89)	0.62 (0.48–0.79)	0.78 (0.3–1.26)

ASR = Age-standardized rate; EAPC = Estimated annual percentage change; UI = Uncertainty interval.

Table 3.

Estimated age-specific prevalence of inflammatory bowel disease (IBD) by GBD regions of Asia and Europe, 1990–2021.

Location	Death (95%UI)
	1990_Number	1990_ASR	1990_Number	1990_ASR	1990_EAPC
East Asia	699.25 (374.24–1102.91)	0.25 (0.13–0.39)	70.49 (41.9–103.69)	0.03 (0.02–0.04)	−5.95 (−6.65 to –5.25)
South Asia	82.45 (20.77–183.83)	0.02 (0.01–0.05)	51.23 (26.1–89.04)	0.01 (0.01–0.02)	−1.89 (−2.07 to –1.7)
Southeast Asia	48.5 (17.27–91.9)	0.03 (0.01–0.06)	31.11 (16.76–43.98)	0.02 (0.01–0.03)	−1.53 (−1.62 to –1.45)
High-income Asia Pacific	4.62 (2.92–6.87)	0.01 (0.01–0.02)	0.5 (0.39–0.68)	0 (0–0)	−5.02 (−5.32 to –4.72)
Central Asia	37.84 (23.08–49.7)	0.17 (0.11–0.22)	21.11 (16.46–27.28)	0.09 (0.07–0.11)	−2.01 (−2.24 to –1.77)
North Africa and Middle East	49.21 (18.88–108.17)	0.04 (0.02–0.09)	40.2 (26.18–60.06)	0.03 (0.02–0.04)	−1.25 (−1.46 to –1.05)
Eastern Europe	17.68 (13.98–20.61)	0.04 (0.03–0.05)	3.35 (2.95–3.81)	0.01 (0.01–0.01)	−3.74 (−4.18 to –3.29)
Western Europe	33.4 (31.15–35.51)	0.06 (0.05–0.06)	15.13 (13.46–16.69)	0.03 (0.02–0.03)	−1.7 (−2.05 to –1.34)
Central Europe	14.15 (11.75–16.81)	0.06 (0.05–0.07)	2.43 (2.01–3.03)	0.02 (0.01–0.02)	−3.46 (−3.68 to –3.25)

ASR = Age-standardized rate; EAPC = Estimated annual percentage change; UI = Uncertainty interval.

Table 4.

Estimated age-specific DALYs of inflammatory bowel disease (IBD) by GBD regions of Asia and Europe, 1990–2021.

Location	DALYs (95%UI)
	1990_Number	1990_ASR	1990_Number	1990_ASR	1990_EAPC
East Asia	60229.52 (32319.62–95037.82)	19.74 (10.59–31.15)	6144.9 (3734.71–8953)	2.38 (1.45–3.48)	−5.95 (−6.66 to –5.24)
South Asia	7414.25 (2180.41–15982.71)	1.83 (0.55–3.94)	5007.98 (2788.65–8332.15)	1.06 (0.58–1.77)	−1.73 (−1.91 to –1.55)
Southeast Asia	4160.52 (1544.54–7849.52)	2.65 (0.97–5.03)	2696.14 (1488.54–3783.86)	1.68 (0.93–2.36)	−1.54 (−1.63 to –1.45)
High-income Asia Pacific	436.94 (297.11–620.93)	1.27 (0.86–1.81)	80.35 (61.15–105.6)	0.36 (0.28–0.48)	−3.91 (−4.11 to –3.71)
Central Asia	3244.94 (1981.23–4264.9)	13.51 (8.32–17.67)	1814.31 (1419.18–2340.13)	6.9 (5.42–8.87)	−1.99 (−2.22 to –1.76)
North Africa and Middle East	4306.72 (1748.5–9249.45)	3.29 (1.35–7.03)	3643.2 (2435.63–5335.61)	2.13 (1.42–3.11)	−1.19 (−1.38 to –0.99)
Eastern Europe	1542.49 (1228.57–1793.81)	3.18 (2.53–3.7)	323.26 (278.6–373.17)	0.97 (0.83–1.11)	−3.63 (−4.06 to –3.19)
Western Europe	3342.76 (3006.85–3710.89)	5.21 (4.71–5.75)	1668.5 (1416.96–1952.34)	2.63 (2.24–3.07)	−1.64 (−1.97 to –1.31)
Central Europe	1283.15 (1062.61–1523.07)	4.86 (4.01–5.78)	257.94 (208.86–326.07)	1.55 (1.25–1.96)	−3.14 (−3.34 to –2.94)

ASR = Age-standardized rate; EAPC = Estimated annual percentage change; UI = Uncertainty interval.

GBD map analysis

This study analyzed the burden of IBD among children aged 0–14 years across 93 countries and regions in Asia and Europe from 1990 to 2021. The GBD map visually portrays age-standardized prevalence, incidence, mortality, and DALY rates (Figure 1). In most Asian countries, incidence and prevalence rates range from 0 to 0.1 cases per 100,000 population, with South Korea exceeding this threshold, surpassing the Asian average. Conversely, most European countries report rates exceeding 0.1 cases per 100,000 population. Eastern European nations (e.g. Ukraine, Poland, Romania) exhibit significantly lower rates compared to Central, Western, and Northern Europe. In Southern Europe, Italy and Greece demonstrate lower incidence rates, with Italy’s prevalence below 0.1 cases per 100,000 population. Overall, IBD incidence and prevalence in Asia are markedly lower than in Europe.

Figure 1.

Global map for 1990–2021, showing the national age-standardized rates of inflammatory bowel disease among children. (A) Age-standardized incidence rate. (B) Age-standardized prevalence rate. (C) Age-standardized mortality rate. (D) Age-standardized disability-adjusted life years (DALYs) rate. ASR, age-standardized rate; DALYs, disability-adjusted life years.

Mortality rates exceed 0.1 cases per 100,000 population in select East Asian, Southeast Asian, and Middle Eastern countries (e.g. Iraq, Syria, Myanmar, Cambodia) and in several European nations (e.g. the UK, Italy, Portugal, Germany, France, Hungary, Slovakia). No significant mortality disparities were observed between Asian and European countries. However, age-standardized DALY rates reveal notable disparities. In Asia, countries such as China, North Korea, Mongolia, Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan, Iraq, and Cambodia report DALY rates exceeding 5.7 cases per 100,000 population. In Europe, the UK, France, Italy, Albania, Armenia, and Azerbaijan exhibit similarly high DALY rates, while Northern European countries report lower rates. Within Asia, economically developed nations like Japan and South Korea, alongside certain Middle Eastern (e.g. Saudi Arabia, Oman, UAE, Iran) and Southeast Asian countries (e.g. Thailand, Malaysia), demonstrate lower DALY rates, with no clear geographical distribution pattern.

Analysis of the SDI correlation

This study also examined the correlation between age-standardized rates (ASRs) of incidence, prevalence, mortality, and DALYs and the SDI across 21 global regions in the GBD database. SDI, a composite measure of socio-demographic development, ranges from 0 to 1, with higher values indicating greater development. It is widely used to explain health outcomes and predict disease burden disparities.

In regions with SDI > 0.6 (e.g. Oceania, Western Europe, high-income North America), the age-standardized incidence rate (ASIR) and ASPR initially increase and then decrease with rising SDI (Figure 2A,B). These regions, characterized by advanced economic and social development, exhibit higher ASIR and ASPR. Conversely, regions with lower SDI (e.g. Central Sub-Saharan Africa, Western Sub-Saharan Africa, North Africa, and the Middle East) show lower ASIR and ASPR, with minimal changes as SDI increases. This may reflect poor health infrastructure, limited diagnostic capabilities, and incomplete medical records, leading to underreporting.

Figure 2.

Socio-demographic Index (SDI) Correlation Analysis from 1990 to 2021, showing the national age-standardized rates of inflammatory bowel disease among children. (A) Age-standardized incidence rates by region for different SDI levels from 1990 to 2021. (B) Age-standardized prevail rates by region for different SDI levels from 1990 to 2021. (C) Age-standardized mortality by region for different SDI levels from 1990 to 2021. (D) Age-standardized disability-adjusted life years (DALYs) rate by region for different SDI levels from 1990 to 2021.

Overall, ASIR and ASPR are higher in economically developed regions of Central Europe, Western Europe, and Asia, particularly in Europe, where they exhibit an initial rise followed by a decline with increasing SDI. Other Asian and European regions show lower ASIR and ASPR, with weak correlations to SDI.

Age-standardized mortality rate (ASMR) and age-standardized DALYs rate reveal more pronounced disparities between Asia and Europe (Figure 2C,D). Latin America, Central Asia, and East Asia, particularly the latter, exhibit the highest ASMR and DALYs globally. Western and Central Europe show relatively higher rates but remain significantly lower than Asia. In most regions, ASMR and DALYs decline consistently with rising SDI, reflecting the impact of improved economic and health conditions in mitigating disease burden. These findings align with the disease’s characteristics, underscoring the role of socio-economic development in reducing health disparities.

Frontier analysis of age-standardized DALY rates

From 1990 to 2021, the disease burden and effective differences of IBD in Asia and Europe have narrowed with socio-demographic development, as measured by the SDI (Figure 3A,C). Figure 3B and D show the 2021 DALYs burden and effective differences, with red and green dots indicating increasing or decreasing trends, respectively.

Figure 3.

Frontier analysis based on SDI and age-standardized IBD DALYs rate in 2021. (A) Frontier analysis of age-standardized DALY rates and the socio-demographic index (SDI) in Asia, 1990–2021. (B) Relationship between SDI and effective differences of DALY rates in Asia (2021). Blue-marked regions indicate smaller effective differences relative to SDI, while red-marked regions indicate larger disparities. (C) Frontier analysis of age-standardized DALY rates and SDI in Europe, 1990–2021. (D) Relationship between SDI and effective differences of DALY rates in Europe (2021). Red and green dots indicate increasing or decreasing disease burden trends.

In Asia, effective differences decrease with socio-demographic development, and higher-SDI regions show greater potential for reducing disease burden (Figure 3B). Blue-marked regions have smaller effective differences relative to SDI, while red-marked regions indicate larger disparities, suggesting greater improvement potential. Asia exhibits imbalanced SDI development, with lower-SDI regions showing smaller differences and higher-SDI regions having larger disparities, highlighting significant potential for burden reduction.

In Europe, effective differences are smaller overall. High-SDI countries like the UK, Germany, the Netherlands, and Monaco show notable improvement potential, while other regions exhibit less pronounced differences and a generally increasing disease burden. These findings highlight varying potential for burden reduction across socio-demographic development levels in Asia and Europe.

Health inequality analysis of age-standardized DALY rates

Analysis of health inequality based on the SDI and age-standardized IBD DALY rates in Asia and Europe in 1990 and 2021 reveals the following: In 2021, the Concentration Index (CI) for Asian countries was significantly closer to the diagonal line compared to 1990 (Figure 4A), indicating improved equity in IBD DALYs among children over the past three decades. In contrast, European CI values showed minimal changes (Figure 4B), reflecting stable equity levels during the same period.

Figure 4.

Health inequality analysis based on the socio-demographic index (SDI) and age-standardized IBD DALYs rates in 1990 and 2021. (A) Concentration index (CI) curve for Asian countries in 1990 and 2021. (B) Concentration index (CI) curve for European countries in 1990 and 2021. (C) Slope index of inequality (SII) in Asia, 1990 vs 2021. (D) Slope index of inequality (SII) in Europe, 1990 vs 2021.

The Slope Index of Inequality (SII) for Asia improved from 1.39 in 1990 to −0.77 in 2021 (Figure 4C), demonstrating significant progress toward equity. For Europe, the SII remained stable at 0.5 in 2021 compared to 0.42 in 1990 (Figure 4D), indicating consistently low health disparities between the most deprived and affluent groups over the past 30 years. While Asian countries exhibited larger health gaps compared to Europe, these disparities have narrowed significantly by 2021, reflecting progress toward equity, though still lagging behind Europe’s level.

Trend forecast analysis for the next decade

The ARIMA model has predicted the trends in incidence and DALYs of IBD among children (ages 0–14) in Asia and Europe over the next decade. The conclusion drawn is that the incidence of IBD among Asian children will continue to rise over the next 10 years (Figure 5A), while the incidence of IBD among European children is expected to stabilize over the same period (Figure 5C). This forecast is derived from the historical incidence data of pediatric IBD in Asia and Europe as recorded in the GBD 2021 dataset, under the assumption that future trends will align with historical patterns. While the ARIMA model effectively captures trends and seasonal variations in time series data, it operates under the prerequisite that the time series is either stationary or can be transformed into stationarity through differencing. Consequently, the forecasted outcomes carry a degree of uncertainty, and the study’s conclusions should be interpreted in conjunction with the prediction intervals to ensure comprehensive evaluation. The DALYs for IBD among children in both Asia and Europe are anticipated to continue declining over the next decade (Figure 5B and D). This trend is associated with evolving sociodemographic factors, the progressive improvement in healthcare standards, and the increasing disease control capabilities in countries and regions across Asia and Europe.

Figure 5.

Predictive models for the incidence and DALYs rates of IBD in children aged 0–14 in Asian and European Countries or regions over the next decade. (A) Predicted incidence of pediatric IBD in Asia (2021–2031). (B) Predicted incidence of pediatric IBD in Europe (2021–2031). (C) Predicted DALYs of pediatric IBD in Asia (2021–2031). (D) Predicted DALYs of pediatric IBD in Europe (2021–2031).

Discussion

This study utilized the 2021 GBD dataset to analyze the disease burden and epidemiological trends of IBD among children aged 0 to 14 years across 93 countries and regions in Asia and Europe from 1990 to 2021. The results revealed an overall increasing trend in the incidence, prevalence, and DALYs of IBD among children in Asia, while a decreasing trend was observed in Europe. Specifically, the prevalence in East Asia increased from 1,265.78 cases (95% UI: 921.46–1,672.24) in 1990 to 1,402.33 cases (95% UI: 1,043.79–1,825.73) in 2021, whereas the prevalence in high-income Asian regions (e.g. Japan, South Korea) decreased from 387.91 cases (95% UI: 303.54–482.97) in 1990 to 249.87 cases (95% UI: 195.63–312.78) in 2021. In Europe, the prevalence of IBD significantly declined during the same period. Furthermore, through GIS visualization, we found that the incidence and prevalence of IBD in Asia were generally lower than in Europe, but mortality and DALYs were higher in some countries in East Asia, Southeast Asia, and the Middle East. Using the ARIMA model, we projected the epidemiological trends of IBD among children aged 0–14 years in Asia and Europe over the next decade. The results indicated that the incidence of IBD in Asia is expected to continue rising, while DALYs are projected to decline. In Europe, the incidence is predicted to stabilize, and DALYs are also expected to decline.

The study highlights that the incidence, prevalence, and DALYs of IBD among children in Asia are on an upward trajectory, whereas Europe shows a downward trend. Recent mechanistic and epidemiologic studies have provided further insight into how environmental transitions may influence pediatric-onset IBD. He et al. [10] demonstrated that global shifts toward high-fat, high-sugar dietary patterns are associated with increased IBD risk, particularly in regions undergoing rapid nutritional transition. Maniyar et al. [13] and Meima et al. [14] further identified specific food compounds and sweetened beverage intake as modulators of intestinal inflammation. Li et al. [15] revealed that alterations in fungal and bacterial microbiome diversity can disrupt mucosal immune regulation, while Estevinho et al. [16] summarized the role of environmental pollutants – such as heavy metals and airborne particulates – in promoting epithelial barrier dysfunction and chronic inflammation. Together, these studies suggest that diet, pollutant exposure, and microbiome dysbiosis interact during critical developmental windows, amplifying immune dysregulation and intestinal inflammation in genetically susceptible children. These findings provide a plausible biological framework to interpret the rising pediatric IBD incidence in rapidly urbanizing Asian populations, complementing our GBD-based epidemiologic trends. In contrast, high-income Asian regions (e.g. Japan, South Korea) have shown relatively stable or declining IBD prevalence [17]. This pattern likely reflects earlier epidemiologic transition, improved disease control, and comprehensive registry coverage rather than a true reduction in new disease occurrence. While advanced healthcare systems and early diagnosis improve patient outcomes and reduce disability, they do not directly influence prevalence. The observed patterns thus represent associations rather than causal effects of medical care. Nevertheless, improved health awareness and preventive efforts may contribute indirectly to long-term stabilization of disease burden through better nutrition, hygiene, and environmental conditions. In Europe, the declining prevalence of IBD is attributed to strengths in disease prevention, health education, and healthcare resource allocation. The relatively stable environment and comprehensive public health measures in Europe also contribute to controlling IBD incidence [18]. Furthermore, medical advancements, such as genetic testing and novel therapeutics, have significantly improved the prognosis of IBD patients, reducing relapse rates and complications [19].

Supplementary analyses revealed divergent IBD epidemiological trajectories between Asia and Europe. Supplementary Figure 1 demonstrated persistently optimized health equity in Europe, contrasting with significant disparities in Asia that reflected fundamental differences in healthcare resource allocation. Supplementary Figure 2 further deconstructed the continental disparities in DALYs, showing that epidemiological improvements outweighed the influence of overall population aging on total disease burden, suggesting that reductions in pediatric IBD DALYs reflect true advances in disease control rather than demographic effects; however, incidence rates exhibited opposing regional trends (positive growth in Asia versus negative trends in Europe), underscoring differential effectiveness of medical interventions. Country-level stratification (Supplementary Figures 3–8) systematically validated the development gradient hypothesis: high-income nations (e.g. Japan, Norway) achieved incidence stabilization through comprehensive registry-based patient retention and follow-up systems, such as the UK IBD Registry, the European Crohn’s and Colitis Organisation (ECCO) E-QUALITY initiative, and national registries in Japan (MIAI) and South Korea. These systems facilitate standardized diagnosis, long-term disease monitoring, and improved data completeness. In contrast, transitional economies (e.g. China, Germany) exhibited urbanization-driven epidemiological fluctuations, while low-resource settings (e.g. Cambodia) displayed underreporting-to-mortality mismatches, reflecting diagnostic and reporting limitations. These multi-scale findings highlight that socioeconomic development enhances the quality of data collection and diagnostic accuracy. However, this improvement also introduces potential confounding, as regions with more advanced healthcare systems and reporting infrastructures may exhibit higher apparent incidence and prevalence rates simply due to improved case ascertainment. Although the GBD 2021 framework incorporates adjustments for these differences through covariates such as Socio-demographic Index, healthcare access, and data completeness, residual bias cannot be completely excluded. Therefore, cross-regional comparisons and temporal trends should be interpreted with caution, acknowledging that part of the observed variation may reflect differences in diagnostic capability and data reporting rather than true epidemiological divergence.

Over the next decade, the incidence of IBD in Asia is likely to continue rising due to ongoing urbanization, Westernization of lifestyles, and the expansion of healthcare infrastructure. As economies develop, diagnostic capacity and disease awareness improve, leading to more cases being recognized and reported. In Europe, the incidence is expected to stabilize, reflecting its well-established healthcare systems and earlier attainment of epidemiologic maturity. Both Asia and Europe are projected to experience declining DALYs, indicating that with better disease management and improved treatment accessibility, the impact of IBD on children will gradually diminish [20].

Our findings are consistent with the global pediatric IBD patterns summarized in the systematic review by Kuenzig et al. [5], which reported a steady increase in pediatric-onset IBD incidence in newly industrialized regions, including Asia, alongside stabilization or decline in traditionally high-incidence Western countries. However, while Kuenzig et al. [5] primarily synthesized data from national and regional registries, our GBD-based analysis extends these observations by providing age-standardized, cross-continental estimates encompassing 93 countries and territories. Similarly, Hracs et al. [3] proposed a global ‘epidemiologic stage model’ describing IBD evolution from emergence to stabilization phases across regions. Our results align with this framework, showing that Asia is currently in an accelerated growth phase of pediatric IBD incidence, whereas Europe demonstrates epidemiologic maturity and declining burden. Notably, the present study provides quantitative confirmation of this model within the pediatric population, emphasizing the importance of socioeconomic transition and healthcare expansion as contextual modifiers of disease trends. Taken together, these comparisons reinforce that our findings not only mirror but also complement registry-based evidence by providing large-scale temporal and geographic insights, while highlighting the need for harmonized data integration between GBD modeling and registry surveillance to refine pediatric IBD epidemiology.

The innovation and strengths of this study lie in its use of the GBD 2021 database, which covers 204 countries and regions, 369 diseases, and 88 risk factors, ensuring representativeness and comprehensiveness of the data and providing a solid scientific foundation. This study is the first to comprehensively analyze IBD data across 93 countries and regions in Asia and Europe, filling a gap in cross-continental, multi-country epidemiological research and overcoming the limitations of previous studies that were often confined to single countries or regions. By focusing on the specific population of children aged 0–14 years, this study reveals their IBD trends and influencing factors, addressing the previous focus on adults and providing new perspectives and data support for pediatric medicine and public health. The study employs advanced statistical methods, including estimated annual percentage change (EAPC), Bayesian age–period–cohort (BAPC) model, and ARIMA model [21], to analyze IBD trends, demographic contributions, and future projections from multiple angles, enhancing the scientific rigor of the research. By comparing data from Asia and Europe, the study uncovers significant differences in disease burden and trends between the two regions, offering a new comparative framework for global IBD research and aiding in understanding regional disease distribution patterns. Additionally, the study incorporates the socio-demographic index (SDI) to explore the complex relationship between economic development and IBD trends, providing new insights into the global distribution of IBD and highlighting the impact of socioeconomic factors on disease burden. The use of the ARIMA model to project future IBD incidence and burden offers forward-looking references for public health policymakers, aiding in the planning of interventions and resource allocation. These innovations not only provide new perspectives and data support for pediatric IBD epidemiology but also offer important scientific evidence for global public health policy and clinical practice, advancing IBD research and laying a theoretical foundation for improving pediatric health outcomes.

Despite its strengths, this study has limitations that warrant attention in future research. One major limitation is the lack of comprehensive primary pediatric IBD datasets across many low- and middle-income countries, particularly in Asia, where national registry systems remain incomplete. Consequently, some of the modeled estimates may rely on data extrapolation rather than direct observation, which introduces uncertainty when interpreting regional comparisons. In addition, there is a possibility of age misclassification between pediatric (0–14 years) and adolescent (15–19 years) cases within the GBD framework, as some source datasets do not clearly distinguish between these age categories. This may have resulted in minor over- or underestimation of incidence and prevalence in certain regions. Moreover, the GBD database does not capture treatment-related factors, genetic susceptibility, or detailed environmental exposure variables. The absence of these parameters limits our ability to assess how therapeutic advances, gene–environment interactions, or pollutant exposures might contribute to the observed epidemiological patterns. Another limitation is the lack of external validation against registry-based pediatric IBD incidence data from high-quality sources, such as the European Crohn’s and Colitis Organisation (ECCO) network and national registries in Japan or South Korea. Incorporating such datasets in future studies would enhance the accuracy and generalizability of GBD-derived estimates. While DALYs provide a useful way to compare disease burden, they do not fully capture the broader social and economic factors – such as poverty, inequality, and environmental conditions – that influence health. Moreover, GBD estimates are produced at national or regional levels, limiting their precision for local health planning. Therefore, our results should be interpreted with caution, and future research using local registries and population-based data is needed to validate these findings. Furthermore, this study focuses on IBD trends and burden but does not delve into underlying causes. Future studies could employ prospective cohort or case–control designs to analyze the relationship between dietary habits, gut microbiota, environmental exposures, and IBD onset. Additionally, this study does not evaluate the effectiveness of existing public health interventions. Future research could incorporate intervention study designs to assess the impact of health education, vaccination, and lifestyle interventions on IBD and conduct cost-effectiveness analyses to inform policy. Finally, this study analyzes IBD as a whole without distinguishing between subtypes such as Crohn’s disease (CD) and ulcerative colitis (UC). Future studies could separately analyze the epidemiological characteristics and trends of different subtypes and incorporate clinical data to explore disease progression, complication rates, and treatment responses, thereby better guiding clinical practice.

This study holds significant implications for public health, epidemiology, and clinical practice. The findings that IBD incidence and burden are rising in Asia but declining or stabilizing in Europe suggest the need for region-specific public health resource allocation [22]. In Asia, particularly in developing countries, enhanced IBD surveillance and management, increased healthcare resource investment, and the formulation of public health policies – such as strengthening primary healthcare, improving diagnostic capabilities, and promoting health education – are essential [23]. These findings echo the global research priorities proposed by Solitano et al. (Nat Rev Gastroenterol Hepatol, 2025), who emphasized strengthening IBD registries, fostering cross-regional data integration, and developing pediatric-specific public health frameworks. For Asia, this highlights the urgent need to invest in standardized registry systems, training of pediatric gastroenterologists, and multi-institutional collaboration to bridge the gap between clinical care and population-level surveillance. Although public health interventions such as improving environmental hygiene, promoting balanced diets, and reducing pollution have broad health benefits, their specific preventive effects on pediatric IBD remain largely theoretical. The associations observed in our analysis do not establish causality, and the underlying mechanisms linking societal development and IBD risk warrant further investigation. Therefore, these findings should be interpreted as associative rather than causal, and future prospective and mechanistic studies are required to validate whether population-level health improvements can directly contribute to IBD risk reduction. Moreover, the analysis of regional disease burden and trends offers data support for optimizing healthcare resource allocation. High-incidence regions may require more specialists, advanced diagnostic equipment, and treatment resources. The study’s findings can help policymakers optimize resource distribution, allocate funding and personnel more effectively, improve healthcare efficiency, and enhance patient outcomes. The declining IBD incidence in high-income Asian regions and most of Europe, likely due to improved medical standards, suggests that policymakers should prioritize medical advancements and disease management optimization, developing targeted health policies such as IBD patient registries, early screening programs, and expanded health insurance coverage. From an epidemiological perspective, this study provides a cross-regional comparative framework for global health research, aiding in identifying regional epidemiological characteristics and public health challenges and fostering international and cross-regional collaborative research to further analyze global IBD trends and influencing factors. Finally, the projection of rising IBD incidence among Asian children over the next decade offers a direction for future research, highlighting the need for studies on the pathogenesis and interventions for IBD in this population, such as prospective cohort studies and intervention trials, to address the anticipated disease burden.

Conclusion

This GBD 2021–based analysis revealed that the pediatric IBD burden has increased across many Asian regions while remaining stable or declining in much of Europe from 1990 to 2021. These findings indicate marked regional heterogeneity that may reflect differences in socioeconomic development, healthcare access, and diagnostic capacity rather than true differences in disease occurrence. Therefore, interpretations should remain cautious. Strengthening pediatric IBD surveillance systems and conducting prospective and mechanistic studies are essential to clarify the underlying drivers of these trends and to guide evidence-based prevention and management strategies.

Funding Statement

This work was supported by the Science and Technology Commission of Shanghai Municipality (grant no. 21Y11923200), Scientific Research Project of Shanghai Municipal Health Commission (grant no. 202340278), and Shanghai Municipal Key Discipline Construction Project of Traditional Chinese Medicine (Clinical Category) (Interdisciplinary Innovation) (grant no. shzyyzdxk-2024111)

Ethical statement

All data used in this study are publicly available: GBD Results. Data analysis was completed on January 30, 2025. The Institutional Review Board of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine determined that ethical approval was not required, as the study used de-identified, publicly available data. All publicly available human samples and data used in this study complied with the principles stated in the 1964 Declaration of Helsinki and its subsequent amendments. All statistical analyses and visualizations were performed using R software version 3.5.1.

Consent for publication

All authors have provided their consent for publication.

Provenance and peer review

Not commissioned, externally peer-reviewed

Disclosure statement

The authors declare that they have no conflict of interest.

Data availability statement

All data utilized in this study are publicly accessible via the following URL: http://ghdx.healthdata.org/gbd-results-tool. The datasets yielded during the study process are available from the corresponding author on reasonable request.