Global and Regional Burden of Crohn's Disease (1990-2023): A Global Burden of Disease Study Analysis.

backgroundCrohn's disease (CD) is an inflammatory bowel disease (IBD) that has evolved into a global health concern, with a rising cumulative burden that makes periodic, up-to-date quantification essential for health-system planning. In recent decades, its incidence has stabilized in early-industrialized regions while rising rapidly in newly industrialized ones, resulting in an increasing cumulative disease burden in high-income regions. This epidemiological transition necessitates precise burden estimation to inform strategic health policies.

methodsThe study was conducted using openly available modeled estimates from the Global Burden of Disease (GBD) 2023 study, in an independent effort to analyze the regional and global burden of CD from 1990 to 2023. This analysis was conducted in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting. Main outcome measures were disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs), expressed as absolute values and age-standardized rates per 100,000 people across 21 GBD regions. The contributions of population growth and age-standardized rate change to the observed DALY were examined after being separated using a two-component decomposition, in addition to the temporal patterns across the whole period. YLLs and YLDs were calculated for each year, and for 2023, male-to-female DALY rate ratios were observed over time.

resultsBetween 1990 and 2023, aggregate DALYs attributable to CD rose from approximately 271,700 to 414,300 (+52.5%), while the age-standardized DALY rate declined modestly (-5.6%). Decomposition indicated that this increase was driven predominantly by demographic change rather than by rising age-standardized risk. Eight of the 21 GBD regions nevertheless showed genuine rate-driven increases, most prominently in Tropical Latin America and in Sub-Saharan Africa. Burden remained highly heterogeneous, with a greater than 20-fold difference between the highest age-standardized rate (Australasia, 19.70 per 100,000; 95% UI: 13.86-26.89) and the lowest (East Asia, 0.95; 95% UI: 0.67-1.30). The YLD share of DALYs rose from 49.2% to 55.4%, indicating a shift toward disability-dominated burden. Male-to-female rate ratios varied widely across regions, with female predominance concentrated in Sub-Saharan Africa. In the North Africa and Middle East region, the age-standardized rate fell by 12.3% while absolute burden nonetheless grew.

conclusionThe global burden of Crohn's has increased since 1990, driven principally by population expansion rather than worsening disease risk. However, genuine rate-driven increases in Tropical Latin America and Sub-Saharan Africa signal epidemiological transitions demanding targeted surveillance and resource allocation. The shift toward disability predominant burden underscores a growing need for long-term disease management globally. These findings are limited to regional aggregates for CD only; country-level analyses incorporating ulcerative colitis data are needed to fully characterize the global IBD burden.