The transition from one stage in the evolution of IBD to the next is a result of human influence: the factors that contribute to these transitions include industrialization, urbanization and westernization of society 10.īy combining epidemiological principles with temporal prevalence trends, a fourth stage can be postulated: Prevalence Equilibrium, the countervailing force between the increasing mortality of an ageing IBD population and the incidence of IBD (Fig. Compounding Prevalence reflects a steady increase in the population living with IBD, despite stabilization or even a decline in incidence 9. Acceleration in Incidence is a tipping point whereby incidence steadily increases over several decades, although prevalence remains low 3. Emergence is represented by sporadic case reports of IBD 2. 1): Emergence, Acceleration in Incidence and Compounding Prevalence. The evolution of IBD occurs within Omran’s Degenerative and Human-Influenced Diseases age and has occurred across three distinct epidemiological stages (Fig. In a 2018 editorial, Kedia and Ahuja postulated that IBD is an example of Omran’s final stage 8. This final stage is a proposed anthropological explanation for the rise in chronic inflammatory conditions 7. Mortality is dominated by non-communicable diseases, the occurrence of which is influenced by environmental pressures such as nutrition and lifestyle behaviours 6. The final transition proposed by Omran was the Age of Degenerative and Human-Influenced Diseases that arises in industrialized and urbanized societies 6. The Age of Receding Pandemics reflects a reduction in mortality crises and a greater burden of endemic diseases (for example, malaria and tuberculosis). The pre-industrial society was labelled the Age of Pestilence and Famine, in which populations were limited by epidemic outbreaks, deprivation and wars.
In 1971, Omran proposed the Epidemiologic Transition Theory to explain human population growth via predominant drivers of mortality 5. Whereas the incidence of IBD in the Western world increased in the twentieth century, the incidence began to increase in newly industrialized countries at the turn of the twenty-first century 4. By the end of the twentieth century, these boundaries had been shattered with the disease recorded on every populated continent of the globe 3, 4.
The distribution of IBD was initially thought to be bound by ethnicity and geography - predominantly affecting people of Western European descent 2. The journey from a few sporadic cases of inflammatory bowel disease (IBD) to millions of people with IBD is a 250-year path beginning with the industrial revolution 1.
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