Analysis and prediction of trends in the disease burden of ulcerative colitis globally and in China from 1990 to 2023_Chinese Journal of Evidence-Based Medicine

Authors：

XU Shenggang ^1,2,3,4 , ZHANG Qingyu ⁵ ,  WANG Jie ⁶ , CAO Yuqing ¹ , CHENG Zihui ⁵ , LI Xiuxia ^2,3,4

1. School of Medicine, Hexi University, Zhangye 734000, P. R. China;
2. School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
3. Center for Evidence-Based Medicine, Lanzhou University, Lanzhou 730000, P. R. China;
4. Gansu Provincial Engineering Research Center for Medical Big Data and Health Technology Assessment, Lanzhou 730000, P. R. China;
5. School of Nursing, Hexi University, Zhangye 734000, P. R. China;
6. Department of Internal Medicine, Linze County People's Hospital, Zhangye 734200, P. R. China;

Corresponding?author：

WANG Jie, Email: xushg417@163.com

Keywords：

Ulcerative colitis; Disease burden; Trend analysis; Prediction

DOI：

10.7507/1672-2531.202511143

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective Based on the Global Burden of Disease Study (GBD 2023) database, this study aims to compare the evolution of the disease burden of ulcerative colitis (UC) globally and in China from 1990 to 2023, and to predict the trends for the period 2024 to 2035. Methods Data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of ulcerative colitis (UC), as well as their corresponding rates at both the global level and in China, were extracted to describe their changing characteristics. Joinpoint regression was used to calculate the annual percent change (APC) and average annual percent change (AAPC). Furthermore, a Bayesian Age-Period-Cohort (BAPC) model was applied to project the disease burden from 2024 to 2035.Results In 2023, the global age-standardized incidence, prevalence, mortality, and DALYs rates of UC were 2.87, 44.19, 0.45, and 13.76 per 100 000 population, respectively. Compared with 1990, the global age-standardized incidence rate slightly increased by 6.69%, while the prevalence, mortality, and DALYs rates decreased by 6.81%, 2.17%, and 12.58%, respectively. From 1990 to 2023, the global age-standardized incidence rate showed an upward trend (AAPC = 0.19, 95%CI 0.16 to 0.22). The age-standardized prevalence and DALYs rates exhibited downward trends, with AAPC of ?0.19 (95%CI ?0.23 to ?0.16) and ?0.40 (95%CI ?0.59 to ?0.20), respectively (all P<0.001). The change in the age-standardized mortality rate was not significant (AAPC = ?0.10, 95%CI ?0.44 to 0.25). In China, the age-standardized incidence, prevalence, mortality, and DALYs rates in 2023 were 1.41, 9.50, 0.23, and 5.94 per 100 000 population, respectively. Compared with 1990, the age-standardized incidence and prevalence rates increased significantly by 88.00% and 66.08%, respectively, whereas the age-standardized mortality and DALYs rates decreased significantly by 60.35% and 58.64%, respectively. From 1990 to 2023, China’s age-standardized incidence and prevalence rates demonstrated an upward trend, with AAPC of 1.81 (95%CI 1.69 to 1.93) and 1.20 (95%CI 1.34 to 1.48), respectively (all P<0.001). The age-standardized mortality and DALYs rates showed a downward trend, with AAPC of ?2.60 (95%CI ?3.11 to ?2.09) and ?2.58 (95%CI ?2.79 to ?2.37), respectively (allP <0.001). Notably, the magnitude of these declines in China was greater than that at the global level and across the five Socio-demographic Index (SDI) regions. Projections from the BAPC model indicated that from 2024 to 2035, the global age-standardized incidence rate will remain basically stable, while the prevalence, mortality, and DALYs rates will slowly decrease. In China, however, the age-standardized incidence and prevalence rates will continue to rise, while the mortality and DALYs rates will continue to decline. Conclusion The mortality and DALYs rates of UC both globally and in China exhibit a downward trend, with a more pronounced decline observed in China. However, the incidence and prevalence burdens of UC in China show an increasing trend and are projected to continue rising over the next decade. Continuous monitoring is required, and more targeted prevention and control measures should be developed in light of the current situation.

Citation： XU Shenggang, ZHANG Qingyu, WANG Jie, CAO Yuqing, CHENG Zihui, LI Xiuxia. Analysis and prediction of trends in the disease burden of ulcerative colitis globally and in China from 1990 to 2023. Chinese Journal of Evidence-Based Medicine, 2026, 26(8): 909-917. doi: 10.7507/1672-2531.202511143 Copy

1.	Ungaro R, Mehandru S, Allen PB, et al. Ulcerative colitis[J]. Lancet, 2017, 389(10080): 1756-1770.
2.	Wangchuk P, Yeshi K, Loukas A. Ulcerative colitis: clinical biomarkers, therapeutic targets, and emerging treatments[J]. Trends Pharmacol Sci, 2024, 45(10): 892-903.
3.	Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review[J]. Gastroenterology, 2012, 142(1): 46-54.
4.	Ng SC, Tang W, Ching JY, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-Pacific Crohn’s and colitis epidemiology study[J]. Gastroenterology, 2013, 145: 158-165.
5.	Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies[J]. Lancet, 2018, 390(10114): 2769-2778.
6.	Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2018, 392(10159): 1789-1858.
7.	Lv H, Jin M, Zhang H, et al. Increasing newly diagnosed inflammatory bowel disease and improving prognosis in China: a 30-year retrospective study from a single centre[J]. BMC Gastroenterol, 2020, 20(1): 377.
8.	賴澤鵬, 吳昀曉, 蔣炬希, 等. 1990-2023年中國50歲以上人群低骨密度相關性骨折的歸因疾病負擔研究[J]. 中國修復重建外科雜志, 2025, 39(11): 1363-1370.
9.	GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023[J]. Lancet, 2025, 406(10513): 1873-1922.
10.	Lai JQ, Li XM, Liu W, et al. Global, regional, and national burden and trends analysis of malignant neoplasm of bone and articular cartilage from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Bone, 2024, 188: 117212.
11.	張越, 張英英, 丁玲, 等. 基于Joinpoint回歸及年齡-時期-隊列模型分析中國腎功能損傷所致心血管病死亡率變化趨勢[J]. 中華疾病控制雜志, 2024, 28(7): 764-783.
12.	魏建仝, 李旭偉, 錢治, 等. 1990-2021年全球、中國及不同社會人口學指數地區痛風的疾病負擔分析及預測研究[J]. 疾病監測, 2025, 40(6): 795-800.
13.	楊明, 汪舒文, 宇傳華. 1990-2019年中國皮膚惡性腫瘤疾病負擔狀況及發病趨勢預測[J]. 中國腫瘤, 2022, 31(11): 853-861.
14.	Hracs L, Windsor JW, Gorospe J, et al. Global IBD Visualization of Epidemiology Studies in the 21st Century (GIVES-21) Research Group. Global evolution of inflammatory bowel disease across epidemiologic stages[J]. Nature. 2025, 642(8067): 458-466.
15.	Piovani D, Danese S, Bonovas S. Environmental risk factors for inflammatory bowel diseases: an umbrella review of meta-analyses[J]. Gastroenterology, 2019, 157(3): 647-659.
16.	Kobayashi T, Siegmund B, Le Berre C, et al. Ulcerative colitis[J]. Nat Rev Dis Primers, 2020, 6(1): 74.
17.	Lewis JD, Abreu MT. Diet as a trigger or therapy for inflammatory bowel diseases[J]. Gastroenterology, 2017, 152(2): 398-414.
18.	Meyer A, Agrawal M, Savin-Shalom E, et al. Impact of diet on inflammatory bowel disease risk: systematic review, meta-analyses and implications for prevention[J]. EClinicalMedicine, 2025, 86: 103353.
19.	Zhai FY, Du SF, Wang ZH, et al. Dynamics of the Chinese diet and the role of urbanicity, 1991–2011[J]. Obes Rev, 2014, 15 Suppl 1(1): 16–26.
20.	Wang Y, Ouyang Q, APDW 2004 Chinese IBD Working Group. Ulcerative colitis in China: retrospective analysis of 3100 hospitalized patients[J]. J Gastroenterol Hepatol, 2007, 22(9): 1450-1455.
21.	Hindson J. Immunosuppressive IBD drugs and COVID-19 vaccine immunogenicity[J]. Nat Rev Gastroenterol Hepatol, 2022, 19(4): 216.
22.	Coward S, Clement F, Benchimol EI, et al. Past and future burden of inflammatory bowel diseases based on modeling of population-based data[J]. Gastroenterology, 2019, 156(5): 1345-1353.
23.	胡品津, 錢家鳴, 吳開春, 等. 我國炎癥性腸病診斷與治療的共識意見(2012年?廣州)[J]. 內科理論與實踐, 2013, 8(1): 61-75.
24.	中華醫學會分會炎癥性腸病學組. 中國消化內鏡技術診斷與治療炎癥腸病的專家組意見[J]. 中華炎性腸病雜志, 2020, 4(4): 283-291.
25.	Kane SV. Systematic review: adherence issues in the treatment of ulcerative colitis[J]. Aliment Pharmacol Ther, 2006, 23(5): 577-585.
26.	Yu T, Li W, Liu Y, et al. Application of internet hospitals in the disease management of patients with ulcerative colitis: retrospective study[J]. J Med Internet Res, 2025, 27: e60019.
27.	Shah SC, Khalili H, Gower-Rousseau C, et al. Sex-based differences in incidence of inflammatory bowel diseases—pooled analysis of population-based studies from western countries[J]. Gastroenterology, 2018, 155(4): 1079-1089.
28.	Turner D, Mack D, Leleiko N, et al. Severe pediatric ulcerative colitis: a prospective multicenter study of outcomes and predictors of response[J]. Gastroenterology, 2010, 138(7): 2282-2291.
29.	Calafat M, Kochar B, Ananthakrishnan AN. A comprehensive review of geriatric syndromes and assessment in older adults with inflammatory bowel diseases[J]. Clin Gastroenterol Hepatol, 2025, 23(7): 1088-1101.

1. Ungaro R, Mehandru S, Allen PB, et al. Ulcerative colitis[J]. Lancet, 2017, 389(10080): 1756-1770.
2. Wangchuk P, Yeshi K, Loukas A. Ulcerative colitis: clinical biomarkers, therapeutic targets, and emerging treatments[J]. Trends Pharmacol Sci, 2024, 45(10): 892-903.
3. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review[J]. Gastroenterology, 2012, 142(1): 46-54.
4. Ng SC, Tang W, Ching JY, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-Pacific Crohn’s and colitis epidemiology study[J]. Gastroenterology, 2013, 145: 158-165.
5. Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies[J]. Lancet, 2018, 390(10114): 2769-2778.
6. Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2018, 392(10159): 1789-1858.
7. Lv H, Jin M, Zhang H, et al. Increasing newly diagnosed inflammatory bowel disease and improving prognosis in China: a 30-year retrospective study from a single centre[J]. BMC Gastroenterol, 2020, 20(1): 377.
8. 賴澤鵬, 吳昀曉, 蔣炬希, 等. 1990-2023年中國50歲以上人群低骨密度相關性骨折的歸因疾病負擔研究[J]. 中國修復重建外科雜志, 2025, 39(11): 1363-1370.
9. GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023[J]. Lancet, 2025, 406(10513): 1873-1922.
10. Lai JQ, Li XM, Liu W, et al. Global, regional, and national burden and trends analysis of malignant neoplasm of bone and articular cartilage from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Bone, 2024, 188: 117212.
11. 張越, 張英英, 丁玲, 等. 基于Joinpoint回歸及年齡-時期-隊列模型分析中國腎功能損傷所致心血管病死亡率變化趨勢[J]. 中華疾病控制雜志, 2024, 28(7): 764-783.
12. 魏建仝, 李旭偉, 錢治, 等. 1990-2021年全球、中國及不同社會人口學指數地區痛風的疾病負擔分析及預測研究[J]. 疾病監測, 2025, 40(6): 795-800.
13. 楊明, 汪舒文, 宇傳華. 1990-2019年中國皮膚惡性腫瘤疾病負擔狀況及發病趨勢預測[J]. 中國腫瘤, 2022, 31(11): 853-861.
14. Hracs L, Windsor JW, Gorospe J, et al. Global IBD Visualization of Epidemiology Studies in the 21st Century (GIVES-21) Research Group. Global evolution of inflammatory bowel disease across epidemiologic stages[J]. Nature. 2025, 642(8067): 458-466.
15. Piovani D, Danese S, Bonovas S. Environmental risk factors for inflammatory bowel diseases: an umbrella review of meta-analyses[J]. Gastroenterology, 2019, 157(3): 647-659.
16. Kobayashi T, Siegmund B, Le Berre C, et al. Ulcerative colitis[J]. Nat Rev Dis Primers, 2020, 6(1): 74.
17. Lewis JD, Abreu MT. Diet as a trigger or therapy for inflammatory bowel diseases[J]. Gastroenterology, 2017, 152(2): 398-414.
18. Meyer A, Agrawal M, Savin-Shalom E, et al. Impact of diet on inflammatory bowel disease risk: systematic review, meta-analyses and implications for prevention[J]. EClinicalMedicine, 2025, 86: 103353.
19. Zhai FY, Du SF, Wang ZH, et al. Dynamics of the Chinese diet and the role of urbanicity, 1991–2011[J]. Obes Rev, 2014, 15 Suppl 1(1): 16–26.
20. Wang Y, Ouyang Q, APDW 2004 Chinese IBD Working Group. Ulcerative colitis in China: retrospective analysis of 3100 hospitalized patients[J]. J Gastroenterol Hepatol, 2007, 22(9): 1450-1455.
21. Hindson J. Immunosuppressive IBD drugs and COVID-19 vaccine immunogenicity[J]. Nat Rev Gastroenterol Hepatol, 2022, 19(4): 216.
22. Coward S, Clement F, Benchimol EI, et al. Past and future burden of inflammatory bowel diseases based on modeling of population-based data[J]. Gastroenterology, 2019, 156(5): 1345-1353.
23. 胡品津, 錢家鳴, 吳開春, 等. 我國炎癥性腸病診斷與治療的共識意見(2012年?廣州)[J]. 內科理論與實踐, 2013, 8(1): 61-75.
24. 中華醫學會分會炎癥性腸病學組. 中國消化內鏡技術診斷與治療炎癥腸病的專家組意見[J]. 中華炎性腸病雜志, 2020, 4(4): 283-291.
25. Kane SV. Systematic review: adherence issues in the treatment of ulcerative colitis[J]. Aliment Pharmacol Ther, 2006, 23(5): 577-585.
26. Yu T, Li W, Liu Y, et al. Application of internet hospitals in the disease management of patients with ulcerative colitis: retrospective study[J]. J Med Internet Res, 2025, 27: e60019.
27. Shah SC, Khalili H, Gower-Rousseau C, et al. Sex-based differences in incidence of inflammatory bowel diseases—pooled analysis of population-based studies from western countries[J]. Gastroenterology, 2018, 155(4): 1079-1089.
28. Turner D, Mack D, Leleiko N, et al. Severe pediatric ulcerative colitis: a prospective multicenter study of outcomes and predictors of response[J]. Gastroenterology, 2010, 138(7): 2282-2291.
29. Calafat M, Kochar B, Ananthakrishnan AN. A comprehensive review of geriatric syndromes and assessment in older adults with inflammatory bowel diseases[J]. Clin Gastroenterol Hepatol, 2025, 23(7): 1088-1101.

Chinese Journal of Evidence-Based Medicine

Analysis and prediction of trends in the disease burden of ulcerative colitis globally and in China from 1990 to 2023

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content