# Sex-specific and socioeconomic disparities in the global burden of inflammatory bowel disease in 204 countries, 1990–2021: projections to 2050

## TL;DR

Inflammatory bowel disease is increasing globally, especially in lower-income regions, with notable differences between sexes and age groups.

## Contribution

This study provides a comprehensive global analysis of IBD trends and disparities linked to socioeconomic factors and sex.

## Key findings

- Global crude counts of IBD metrics increased significantly from 1990 to 2021, while age-standardized rates declined.
- Low- and middle-SDI regions showed the fastest rise in IBD incidence and prevalence, correlating with increasing SDI.
- Females experienced higher disability and prevalence in mid-life and very old age, highlighting sex-specific disparities.

## Abstract

Inflammatory bowel disease (IBD) represents a growing global health challenge, necessitating a systematic evaluation of its epidemiological trends and sociodemographic disparities.

Using Global Burden of Disease 2021 data, we quantified IBD burden (incidence, mortality, prevalence, disability-adjusted life years [DALYs], years lived with disability [YLDs], and years of life lost [YLLs]) across 204 countries and territories from 1990 to 2021, and projected trends to 2050, evaluating associations with Sociodemographic Index (SDI) and sex disparities.

Between 1990 and 2021, global crude counts of incident cases, deaths, prevalence, DALYs, YLDs, YLLs increased by 88.3%, 98.1%, 76.5%, 59.2%, 75.1%, and 50.8%, respectively. However, age-standardized rates (ASRs) of mortality, prevalence, DALYs, YLDs, and YLLs declined by 13.0%, 6.5%, 16.1%, 6.6%, and 21.0%, respectively, contrasting with a modest rise in age-standardized incidence rates (ASIR, 5.5%). The average annual percentage changes (AAPCs) of Incidence, Mortality, Prevalence, DALYs, YLDs, and YLLs were 0.1582, -0.4885, -0.2223, -0.5704, -0.2237, -0.7686, respectively. Projections to 2050 indicate continued reductions in ASRs across all metrics. High and middle-high SDI regions retained the highest absolute burdens, yet low to middle-SDI regions exhibited the steepest escalation in crude incidence and prevalence, correlating strongly with rising SDI (Spearman’s ρ=0.599 for incidence). Females showed a bimodal pattern, with higher disability and prevalence in both mid-life and very old age groups.

High-SDI regions remain IBD epicenters, but accelerating burdens in low- and middle-SDI areas demand context-specific interventions. Persistent sex/age disparities necessitate tailored healthcare strategies to address the evolving global burden.