Promoting equity in inflammatory bowel disease: a global approach to care

Since the turn of the century, shifts in epidemiology indicate the emergence of inflammatory bowel disease (IBD) as a truly global disease with a global health-care burden. The rapid increase in the incidence of IBD in western countries (North America and western Europe) has stabilised, but the compound prevalence in these regions is predicted to reach 1% in 2030. 1 Kaplan GG Windsor JW The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021; 18: 56-66 Crossref PubMed Scopus (399) Google Scholar This rising burden of disease, and the growing complexities of multimorbidity, will undoubtedly worsen inequality in access to high-quality IBD care and affordability of IBD care to health-care systems. Parallel to this scenario in western countries, IBD incidence is rapidly accelerating in regions such as Asia, South America, eastern Europe, and Africa, with conservative estimates predicting more than 10 million new IBD cases in these regions alone by 2050, easily surpassing the current prevalence in western countries. 1 Kaplan GG Windsor JW The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021; 18: 56-66 Crossref PubMed Scopus (399) Google Scholar , 2 GBD 2017 Inflammatory Bowel Disease Collaborators The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020; 5: 17-30 Summary Full Text Full Text PDF PubMed Scopus (1086) Google Scholar , 3 Wang R Li Z Liu S Zhang D Global, regional, and national burden of inflammatory bowel disease in 204 countries and territories from 1990–2019: a systematic analysis based on the Global Burden of Disease Study 2019. BMJ Open. 2023; 13: e065186 Google Scholar Unfortunately, this rapid increase in IBD incidence in newly industrialised nations, such as China, India, Brazil, and other low-income and lower-middle-income countries (LLMICs), has come at a time of increasing inequalities in health-care access across the world. IBD is not immune to these global inequalities. 4 Odufalu FD Dubinsky MC Peyrin-Biroulet L et al. Clinical health care disparities, social determinants of health, and emotional impacts in patients with ulcerative colitis: results from a global ulcerative colitis narrative patient survey. Inflamm Bowel Dis. 2023; published online June 10. https://doi.org/10.1093/ibd/izad102 Crossref Scopus (0) Google Scholar These new heights of IBD burden should therefore be considered in planning sustainable and equitable IBD care in the 21st century and beyond. Furthermore, at the population level, there is increasing evidence that upstream social determinants of health (eg, gender discrimination, poverty, rural dwelling, and racism) can affect midstream social determinants of health (eg, scarcity of diagnostic facilities, limited access to specialised care and treatment, and poor dietary habits) alone or in combination. 5 Anyane-Yeboa A Quezada S Rubin DT Balzora S The impact of the social determinants of health on disparities in inflammatory bowel disease. Clin Gastroenterol Hepatol. 2022; 20: 2427-2434 Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar These determinants eventually result in poor downstream outcomes in IBD (eg, delayed diagnosis, increased hospitalisation, and surgery). 5 Anyane-Yeboa A Quezada S Rubin DT Balzora S The impact of the social determinants of health on disparities in inflammatory bowel disease. Clin Gastroenterol Hepatol. 2022; 20: 2427-2434 Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar