Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Perspective
  • Published:

The four epidemiological stages in the global evolution of inflammatory bowel disease

Nature Reviews Gastroenterology & Hepatology volume 18, pages 56–66 (2021)Cite this article

Subjects

Abstract

Inflammatory bowel disease (IBD) is a global disease; its evolution can be stratified into four epidemiological stages: Emergence, Acceleration in Incidence, Compounding Prevalence and Prevalence Equilibrium. In 2020, developing countries are in the Emergence stage, newly industrialized countries are in the Acceleration in Incidence stage, and Western regions are in the Compounding Prevalence stage. Western regions will eventually transition to the Prevalence Equilibrium stage, in which the accelerating prevalence levels off as the IBD population ages and possibly as a result of an unexpected rise in mortality during the COVID-19 pandemic. Mitigating the global burden of IBD will require concerted efforts in disease prevention and health-care delivery innovations that respond to changing demographics of the global IBD population. In this Perspective, we summarize the global epidemiology of IBD and use these data to stratify disease evolution into four epidemiological stages.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Four epidemiological stages of IBD evolution.
Fig. 2: Coalescing Incidence Ranges for IBD in regions in the Western world.
Fig. 3: The interplay and determinants of IBD incidence, prevalence and mortality.
Fig. 4: Global map of the epidemiological stages of IBD evolution in 2020.

Similar content being viewed by others

References

  1. Kaplan, G. G. The global burden of IBD: from 2015 to 2025. Nat. Rev. Gastroenterol. Hepatol. 12, 720–727 (2015).

    Article  PubMed  Google Scholar 

  2. Kaplan, G. G. & Ng, S. C. Globalisation of inflammatory bowel disease: perspectives from the evolution of inflammatory bowel disease in the UK and China. Lancet Gastroenterol. Hepatol. 1, 307–316 (2016).

    Article  PubMed  Google Scholar 

  3. Molodecky, N. A. et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142, 46–54 (2012).

    Article  PubMed  Google Scholar 

  4. Ng, S. C. et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 390, 2769–2778 (2018).

    Article  Google Scholar 

  5. Omran, A. R. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem. Fund. Q. 49, 509–538 (1971).

    Article  CAS  PubMed  Google Scholar 

  6. Barrett, B., Charles, J. W. & Temte, J. L. Climate change, human health, and epidemiological transition. Prev. Med. 70, 69–75 (2015).

    Article  PubMed  Google Scholar 

  7. Zuckerman, M. K., Harper, K. N., Barrett, R. & Armelagos, G. J. The evolution of disease: anthropological perspectives on epidemiologic transitions. Glob. Health Action. 7, 23303 (2014).

    Article  PubMed  Google Scholar 

  8. Kedia, S. & Ahuja, V. Is the emergence of inflammatory bowel disease a prime example of “the third epidemiological transition”? Indian J. Gastroenterol. 37, 183–185 (2018).

    Article  PubMed  Google Scholar 

  9. Coward, S. et al. Past and future burden of inflammatory bowel diseases based on modeling of population-based data. Gastroenterology 156, 1345–1353 (2019).

    Article  PubMed  Google Scholar 

  10. Kaplan, G. G. & Ng, S. C. Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology 152, 313–321 (2017).

    Article  PubMed  Google Scholar 

  11. Darwin, C. On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life (J. Murray, 1859).

  12. Orrego, F. & Quintana, C. Darwin’s illness: a final diagnosis. Notes Rec. R. Soc. Lond. 61, 23–29 (2007).

    Article  PubMed  Google Scholar 

  13. Baillie, M. The Morbid Anatomy of Some of the Most Important Parts of the Human Body (J. Johnson, 1793).

  14. Abercrombie, J. Pathological and Practical Researches on Diseases of the Stomach, the Intestinal Canal, the Liver and other Viscera of the Abdomen (Carey & Lea, 1828).

  15. Wilks, S. Morbid appearances in the intestine of Miss Bankes. Lond. Med. Gazette 2, 264 (1859).

    Google Scholar 

  16. White, H. A discussion on “ulcerative colitis.” Introductory address. Proc. R. Soc. Med. 2, 79–82 (1909).

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Mulder, D. J., Noble, A. J., Justinich, C. J. & Duffin, J. M. A tale of two diseases: the history of inflammatory bowel disease. J. Crohns Colitis 8, 341–348 (2014).

    Article  PubMed  Google Scholar 

  18. Allchin, W. H. A discussion on “ulcerative colitis”: introductory address. Proc. R. Soc. Med. 2, 59–75 (1909).

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Dalziel, T. K. Chronic interstitial enteritis. Br. Med. J. 2, 1068–1070 (1913).

    Google Scholar 

  20. Crohn, B. B., Ginzburg, L. & Oppenheimer, G. D. Regional ileitis: a pathologic and clinical entity. J. Am. Med. Assoc. 99, 1323–1329 (1932).

    Article  Google Scholar 

  21. Chopra, R. N. & Ray, P. N. Chronic ulcerative colitis. Ind. Med. Gaz. 74, 65–74 (1939).

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Jiang, X. L. & Cui, H. F. An analysis of 10218 ulcerative colitis cases in China. World J. Gastroenterol. 8, 158–161 (2002).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Crutzen, P. J. & Stoermer, E. F. Anthropocene. IGBP Glob. Change Newslet. 41, 17–18 (2000).

    Google Scholar 

  24. Waters, C. N. et al. The Anthropocene is functionally and stratigraphically distinct from the Holocene. Science 351, aad2622 (2016).

    Article  PubMed  CAS  Google Scholar 

  25. Steffen, W., Broadgate, W., Deutsch, L., Gaffney, O. & Ludwig, C. The trajectory of the Anthropocene: the Great Acceleration. Anthr. Rev. 2, 81–98 (2015).

    Google Scholar 

  26. Roser M., Ritchie H. & Ortiz-Ospina E. World Population Growth. https://ourworldindata.org/world-population-growth (2019).

  27. Steffen, W., Crutzen, J. & McNeill, J. R. The Anthropocene: are humans now overwhelming the great forces of Nature? Ambio 36, 614–621 (2007).

    Article  CAS  PubMed  Google Scholar 

  28. Shivashankar, R., Tremaine, W. J., Harmsen, W. S. & Loftus, E. V. Jr. Incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted county, Minnesota from 1970 through 2010. Clin. Gastroenterol. Hepatol. 15, 857–863 (2017).

    Article  PubMed  Google Scholar 

  29. Gunesh, S., Thomas, G. A., Williams, G. T., Roberts, A. & Hawthorne, A. B. The incidence of Crohn’s disease in Cardiff over the last 75 years: an update for 1996–2005. Aliment. Pharmacol. Ther. 27, 211–219 (2008).

    Article  CAS  PubMed  Google Scholar 

  30. Mayberry, J., Rhodes, J. & Hughes, L. E. Incidence of Crohn’s disease in Cardiff between 1934–1977. Gut 20, 602–608 (1979).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Rose, J. D., Roberts, G. M., Williams, G., Mayberry, J. F. & Rhodes, J. Cardiff Crohn’s disease jubilee: the incidence over 50 years. Gut 29, 346–351 (1988).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Loftus, E. V. Jr. et al. Ulcerative colitis in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gut 46, 336–343 (2000).

    Article  PubMed  PubMed Central  Google Scholar 

  33. Jacobsen, B. A. et al. Increase in incidence and prevalence of inflammatory bowel disease in northern Denmark: a population-based study, 1978–2002. Eur. J. Gastroenterol. Hepatol. 18, 601–606 (2006).

    Article  PubMed  Google Scholar 

  34. Björnsson, S. Inflammatory bowel disease in Iceland during a 30-year period, 1950–1979. Scand. J. Gastroenterol. Suppl. 170, 47–79 (1989).

    Article  PubMed  Google Scholar 

  35. Lakatos, L. et al. Striking elevation in incidence and prevalence of inflammatory bowel disease in a province of western Hungary between 1977–2001. World J. Gastroenterol. 10, 404–409 (2004).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kaplan, G. G. et al. The impact of inflammatory bowel disease in Canada 2018: epidemiology. J. Can. Assoc. Gastroenterol. 2, S6–S16 (2019).

    Article  PubMed  Google Scholar 

  37. Benchimol, E. I. et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm. Bowel Dis. 20, 1761–1769 (2014).

    Article  PubMed  Google Scholar 

  38. Roberts S. E. et al. A systematic review and meta analysis of paediatric inflammatory bowel disease incidence and prevalence across Europe. J. Crohns Colitis https://doi.org/10.1093/ecco-jcc/jjaa037 (2020).

  39. Benchimol, E. I. et al. Incidence, outcomes, and health services burden of very early onset inflammatory bowel disease. Gastroenterology 147, 803–813 (2014).

    Article  PubMed  Google Scholar 

  40. Su, H. Y., Gupta, V., Day, A. S. & Gearry, R. B. Rising incidence of inflammatory bowel disease in Canterbury, New Zealand. Inflamm. Bowel Dis. 22, 2238–2244 (2016).

    Article  PubMed  Google Scholar 

  41. Chaaro Benallal, D. et al. Evolution of the incidence of inflammatory bowel disease in Southern Spain. Rev. Esp. Enferm. Dig. 109, 757–760 (2017).

    PubMed  Google Scholar 

  42. Lophaven, S. N., Lynge, E. & Burisch, J. The incidence of inflammatory bowel disease in Denmark 1980–2013: a nationwide cohort study. Aliment. Pharmacol. Ther. 45, 961–972 (2017).

    Article  CAS  PubMed  Google Scholar 

  43. Leddin, D., Tamim, H. & Levy, A. R. Decreasing incidence of inflammatory bowel disease in eastern Canada: a population database study. BMC Gastroenterol. 14, 140 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hammer, T., Nielsen, K. R., Munkholm, P., Burisch, J. & Lynge, E. The Faroese IBD study: incidence of inflammatory bowel diseases across 54 years of population-based data. J. Crohns Colitis. 10, 934–942 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  45. Molodecky, N. A. et al. Challenges associated with identifying the environmental determinants of the inflammatory bowel diseases. Inflamm. Bowel Dis. 17, 1792–1799 (2011).

    Article  PubMed  Google Scholar 

  46. Hammer, T. et al. Dietary risk factors for inflammatory bowel diseases in a high-risk population: results from the Faroese IBD study. U. Eur. Gastroenterol. J. 7, 924–932 (2019).

    Article  CAS  Google Scholar 

  47. Abdulla, M. et al. Inflammatory bowel disease in Bahrain: single-center experience. Clin. Exp. Gastroenterol. 10, 133–145 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mokhtar, N. M. et al. A four-decade analysis of the incidence trends, sociodemographic and clinical characteristics of inflammatory bowel disease patients at single tertiary centre, Kuala Lumpur, Malaysia. BMC Public Health 19, 550 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kotze, P. G. et al. Progression of inflammatory bowel diseases throughout Latin America and the Caribbean: a systematic review. Clin. Gastroenterol. Hepatol. 18, 304–312 (2020).

    Article  PubMed  Google Scholar 

  50. Victoria, C. R., Sassak, L. Y. & Nunes, H. R. Incidence and prevalence rates of inflammatory bowel diseases, in midwestern of Sao Paulo State, Brazil. Arq. Gastroenterol. 46, 20–25 (2009).

    Article  PubMed  Google Scholar 

  51. Gasparini, R. G., Sassaki, L. Y. & Saad-Hossne, R. Inflammatory bowel disease epidemiology in Sao Paulo State, Brazil. Clin. Exp. Gastroenterol. 11, 423–429 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ng, S. C. et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-Pacific Crohn’s and colitis epidemiology study. Gastroenterology 145, 158–165 (2013).

    Article  PubMed  Google Scholar 

  53. Ng, S. C. et al. Population density and risk of inflammatory bowel disease: a prospective population-based study in 13 countries or regions in Asia-Pacific. Am. J. Gastroenterol. 114, 107–115 (2019).

    Article  PubMed  Google Scholar 

  54. Ananthakrishnan, A. N. Epidemiology and risk factors for IBD. Nat. Rev. Gastroenterol. Hepatol. 12, 205–217 (2015).

    Article  PubMed  Google Scholar 

  55. Mak, W. Y., Zhao, M., Ng, S. C. & Burisch, J. The epidemiology of inflammatory bowel disease: East meets west. J. Gastroenterol. Hepatol. 35, 380–389 (2020).

    Article  PubMed  Google Scholar 

  56. Ng, S. C. et al. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut 64, 1063–1071 (2015).

    Article  PubMed  Google Scholar 

  57. Kedia, S. & Ahuja, V. Epidemiology of inflammatory bowel disease in India: the great shift east. Inflamm. Intest. Dis. 2, 102–115 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  58. Freeman, J. & Hutchison, G. B. Prevalence, incidence and duration. Am. J. Epidemiol. 112, 707–723 (1980).

    Article  CAS  PubMed  Google Scholar 

  59. Feenstra, T. L., van Genugten, M. L., Hoogenveen, R. T., Wouters, E. F. & Rutten-van Mölken, M. P. The impact of aging and smoking on the future burden of chronic obstructive pulmonary disease: a model analysis in the Netherlands. Am. J. Respir. Crit. Care Med. 164, 590–596 (2001).

    Article  CAS  PubMed  Google Scholar 

  60. Brookmeyer, R. & Gray, S. Methods for projecting the incidence and prevalence of chronic diseases in aging populations: application to Alzheimer’s disease. Stat. Med. 19, 1481–1493 (2000).

    Article  CAS  PubMed  Google Scholar 

  61. Etzioni, R., Cha, R., Feuer, E. J. & Davidov, O. Asymptomatic incidence and duration of prostate cancer. Am. J. Epidemiol. 148, 775–785 (1998).

    Article  CAS  PubMed  Google Scholar 

  62. Gail, M. H., Kessler, L., Midthune, D. & Scoppa, S. Two approaches for estimating disease prevalence from population-based registries of incidence and total mortality. Biometrics 55, 1137–1144 (1999).

    Article  CAS  PubMed  Google Scholar 

  63. Bitton, A., Vutcovici, M., Sewitch, M., Suissa, S. & Brassard, P. Mortality trends in Crohn’s disease and ulcerative colitis: a population-based study in Quebec, Canada. Inflamm. Bowel Dis. 22, 416–423 (2016).

    Article  PubMed  Google Scholar 

  64. Burisch, J. et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 63, 588–597 (2014).

    Article  CAS  PubMed  Google Scholar 

  65. Coward, S. et al. The evolving incidence of inflammatory bowel disease: what will the future hold? J. Can. Assoc. Gastroenterol. 2, 56–58 (2019).

    Article  PubMed Central  Google Scholar 

  66. Benchimol, E. I. et al. Inflammatory bowel disease in immigrants to Canada and their children: a population-based cohort study. Am. J. Gastroenterol. 110, 553–563 (2015).

    Article  PubMed  Google Scholar 

  67. Sedlack, R. E., Nobrega, F. T., Kurland, L. T. & Sauer, W. G. Inflammatory colon disease in Rochester, Minnesota, 1935-1964. Gastroenterology 62, 935–941 (1972).

    Article  CAS  PubMed  Google Scholar 

  68. Loftus, E. V. Jr. et al. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology 114, 1161–1168 (1998).

    Article  PubMed  Google Scholar 

  69. Jones, G. R. et al. IBD prevalence in Lothian, Scotland, derived by capture-recapture methodology. Gut 68, 1953–1960 (2019).

    Article  PubMed  Google Scholar 

  70. Coward S. Forecasting the Future: A Trek through the Changing Landscape of Inflammatory Bowel Disease. Thesis, Univ. Calgary (2019).

  71. Knickman, J. R. & Snell, E. K. The 2030 problem: caring for aging baby boomers. Health Serv. Res. 37, 849–884 (2002).

    Article  PubMed  PubMed Central  Google Scholar 

  72. Muszynska, M. M. & Rau, R. The old-age healthy dependency ratio in Europe. J. Popul. Ageing 5, 151–162 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  73. Sanderson, W. C. & Scherbov, S. Average remaining lifetimes can increase as human populations age. Nature 435, 811–813 (2005).

    Article  CAS  PubMed  Google Scholar 

  74. Appleby, J. How long can we expect to live? BMJ 346, f331 (2013).

    Article  PubMed  Google Scholar 

  75. Nguyen, G. C. et al. The impact of inflammatory bowel disease in Canada 2018: IBD in seniors. J. Can. Assoc. Gastroenterol. 2, S68–S72 (2019).

    Article  PubMed  Google Scholar 

  76. Bernstein, C. N., Nugent, Z., Targownik, L. E., Singh, H. & Lix, L. M. Predictors and risks for death in a population-based study of persons with IBD in Manitoba. Gut 64, 1403–1411 (2015).

    Article  PubMed  Google Scholar 

  77. Windsor, J. W. et al. Parallel epidemiologies in newly vs. highly industrialized countries. J. Can. Assoc. Gastroenterol. 3, 34–35 (2020).

    Article  PubMed Central  Google Scholar 

  78. Yen, H. H. et al. Epidemiological trend in inflammatory bowel disease in Taiwan from 2001 to 2015: a nationwide populationbased study. Intest. Res. 17, 54–62 (2019).

    Article  PubMed  Google Scholar 

  79. Kwak, M. S. et al. Emerging trends of inflammatory bowel disease in South Korea: a nationwide population-based study. J. Gastroenterol. Hepatol. 34, 1018–1026 (2019).

    Article  PubMed  Google Scholar 

  80. Organisation for Economic Co-operation and Development (2017) Pensions at a Glance 2017: OECD and G20 Indicators 122–123 (OECD, 2017).

  81. Bar-Gil Shitrit, A. et al. Inflammatory bowel disease: an emergent disease among Ethiopian Jews migrating to Israel. Inflamm. Bowel Dis. 21, 631–635 (2015).

    Article  PubMed  Google Scholar 

  82. Archampong, T. N. & Nkrumah, K. N. Inflammatory bowel disease in Accra: what new trends. West. Afr. J. Med. 32, 40–44 (2013).

    CAS  PubMed  Google Scholar 

  83. Khalifa, S. E., Mudawi, H. M. & Fedail, S. S. Presentation and management outcome of inflammatory bowel disease in Sudan. Trop. Gastroenterol. 26, 194–196 (2005).

    CAS  PubMed  Google Scholar 

  84. Ng, W. K., Wong, S. H. & Ng, S. C. Changing epidemiological trends of inflammatory bowel disease in Asia. Intest. Res. 14, 111–119 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  85. Morita, N. et al. Incidence and prevalence of inflammatory bowel disease in Japan: nationwide epidemiological survey during the year 1991. J. Gastroenterol. 30 (Suppl. 8), 1–4 (1995).

    PubMed  Google Scholar 

  86. Asakura, K. et al. Prevalence of ulcerative colitis and Crohn’s disease in Japan. J. Gastroenterol. 44, 659–665 (2009).

    Article  PubMed  Google Scholar 

  87. Murakami, Y. et al. Estimated prevalence of ulcerative colitis and Crohn’s disease in Japan in 2014: an analysis of a nationwide survey. J. Gastroenterol. 54, 1070–1077 (2019).

    Article  CAS  PubMed  Google Scholar 

  88. Yang, S. K. et al. Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986–2005: a KASID study. Inflamm. Bowel Dis. 14, 542–549 (2008).

    Article  PubMed  Google Scholar 

  89. Ye, L., Cao, Q. & Cheng, J. Review of inflammatory bowel disease in China. ScientificWorldJournal 2013, 296470 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  90. Regueiro, M. et al. Reduced unplanned care and disease activity and increased quality of life after patient enrollment in an inflammatory bowel disease medical home. Clin. Gastroenterol. Hepatol. 16, 1777–1785 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  91. Flamant, M. & Roblin, X. Inflammatory bowel disease: towards a personalized medicine. Ther. Adv. Gastroenterol. 11, 1756283X17745029 (2018).

    Article  Google Scholar 

  92. Cross, R. K. et al. A randomized controlled trial of TELEmedicine for patients with inflammatory bowel disease (TELE-IBD). Am. J. Gastroenterol. 114, 472–482 (2019).

    Article  PubMed  Google Scholar 

  93. Ananthakrishnan, A. N. et al. Use of narrative concepts in electronic health records to validate associations between genetic factors and response to treatment of inflammatory bowel diseases. Clin. Gastroenterol. Hepatol. 18, 1890–1892 (2020).

    Article  PubMed  Google Scholar 

  94. Stidham, R. W. et al. Performance of a deep learning model vs human reviewers in grading endoscopic disease severity of patients with ulcerative colitis. JAMA Netw. Open 2, e193963 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  95. Waljee, A. K. et al. Development and validation of machine learning models in prediction of remission in patients with moderate to severe Crohn disease. JAMA Netw. Open 2, e193721 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  96. Wu, F. et al. A new coronavirus associated with human respiratory disease in China. Nature 579, 265–269 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  97. Brenner, E. J. et al. Corticosteroids, but not TNF antagonists, are associated with adverse COVID-19 outcomes in patients with inflammatory bowel diseases: results from an international registry. Gastroenterology 159, 481–491 (2020).

    Article  CAS  PubMed  Google Scholar 

  98. World Bank. Health Nutrition and Population Statistics. https://databank.worldbank.org/source/health-nutrition-and-population-statistics (2020).

  99. United Nations. United Nations World Economic Situation and Prospects. https://www.un.org/development/desa/dpad/wp-content/uploads/sites/45/WESP2019_BOOK-web.pdf (2019).

Download references

Acknowledgements

The authors thank F. Underwood and S. Coward for contributing to the article through literature searches, providing advice and graphic design. The authors have received funding from the Canadian Institutes for Health Research Operating Grant reference number PJT 162393.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Gilaad G. Kaplan & Joseph W. Windsor

  2. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    Gilaad G. Kaplan & Joseph W. Windsor

Authors
  1. Gilaad G. Kaplan
    View author publications

    Search author on:PubMed Google Scholar

  2. Joseph W. Windsor
    View author publications

    Search author on:PubMed Google Scholar

Contributions

The authors contributed equally to all aspects of the article.

Corresponding author

Correspondence to Gilaad G. Kaplan.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Peer review information

Nature Reviews Gastroenterology & Hepatology thanks V. Ahuja, J. Burisch and M. Kappelman for their contribution to the peer review of this work.

Publisher’s note

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

Related links

Global IBD Visualization of Epidemiology Studies: https://wpsites.ucalgary.ca/gilkaplan/ioibd-gives/

Kaplan Lab interactive maps: https://wpsites.ucalgary.ca/gilkaplan/

SECURE-IBD interactive map: https://wpsites.ucalgary.ca/gilkaplan/secure-ibd/

Video Abstract: https://youtu.be/6Cp7TAcc8XM

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaplan, G.G., Windsor, J.W. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 18, 56–66 (2021). https://doi.org/10.1038/s41575-020-00360-x

Download citation

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41575-020-00360-x

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing