Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific
Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific
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DOI：
10.1038/s41395-018-0233-2
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发表时间：
2019-01-01
影响因子：
9.8
通讯作者：
Sung, Joseph J. Y.
中科院分区：
文献类型：
--
作者：
Ng, Siew C.;Kaplan, Gilaad G.;Sung, Joseph J. Y.
简介：生活在城市环境中可能会增加患炎症性肠病（IBD）的风险。目前尚不清楚这一现象是否在全球范围内出现。我们进行了一项基于人群的研究，以评估亚太地区城市化与 IBD 发病率之间的关系。方法：纳入亚太地区 13 个国家或地区 2011 年至 2013 年新诊断的 IBD 病例。使用 95% 置信区间 (CI) 计算发生率，并使用随机效应模型进行汇总。 Meta 回归分析用于评估发病率及其与人口密度、纬度和经度的关联。结果：我们确定了 1175 例溃疡性结肠炎 (UC)、656 例克罗恩病 (CD) 和 37 例未确定的 IBD (IBD-U)。每 10 万人中 IBD 的平均年发病率为 1.50（95% CI：1.43-1.57）。印度（9.31；95% CI：8.38-10.31）和中国（3.64；95% CI，2.97-4.42）是亚洲 IBD 发病率最高的国家。在亚洲人口密度较高的 19 个地区，IBD（发病率比 [IRR]：2.19；95% CI：1.01-4.76]）和 CD（IRR：3.28；95% CI：1.83-9.12）的总体发病率较高。在中国，IBD（IRR：2.37；95% CI：1.10-5.16）和UC（IRR：2.63；95% CI：1.2-5.8）的发病率与国内生产总值呈正相关。在中国，IBD 发病率存在从南到北的疾病梯度（IRR：0.94；95% CI：0.91-0.98），CD 发病率存在从西到东的梯度（IRR：1.14；95% CI：1.05-1.24）。这项研究获得了 IRB 的批准。结论：亚洲人口密度高的地区 CD 和 UC 的发病率较高。中国沿海地区IBD发病率较高。随着城市化进程的加快以及从农村地区向城市的转变，亚洲的发病率可能会继续攀升。
INTRODUCTION: Living in an urban environment may increase the risk of developing inflammatory bowel disease (IBD). It is unclear if this observation is seen globally. We conducted a population-based study to assess the relationship between urbanization and incidence of IBD in the Asia-Pacific region.METHODS: Newly diagnosed IBD cases between 2011 and 2013 from 13 countries or regions in Asia-Pacific were included. Incidence was calculated with 95% confidence interval (CI) and pooled using random-effects model. Meta-regression analysis was used to assess incidence rates and their association with population density, latitude, and longitude.RESULTS: We identified 1175 ulcerative colitis (UC), 656 Crohn's disease (CD), and 37 IBD undetermined (IBD-U). Mean annual IBD incidence per 100 000 was 1.50 (95% CI: 1.43-1.57). India (9.31; 95% CI: 8.38-10.31) and China (3.64; 95% CI, 2.97-4.42) had the highest IBD incidence in Asia. Incidence of overall IBD (incidence rate ratio [IRR]: 2.19; 95% CI: 1.01-4.76]) and CD (IRR: 3.28; 95% CI: 1.83-9.12) was higher across 19 areas of Asia with a higher population density. In China, incidence of IBD (IRR: 2.37; 95% CI: 1.10-5.16) and UC (IRR: 2.63; 95% CI: 1.2-5.8) was positively associated with gross domestic product. A south-to-north disease gradient (IRR: 0.94; 95% CI: 0.91-0.98) was observed for IBD incidence and a west-to-east gradient (IRR: 1.14; 95% CI: 1.05-1.24) was observed for CD incidence in China. This study received IRB approval.CONCLUSIONS: Regions in Asia with a high population density had a higher CD and UC incidence. Coastal areas within China had higher IBD incidence. With increasing urbanization and a shift from rural areas to cities, disease incidence may continue to climb in Asia.