Clinical characteristics and north-south differences of inflammatory bowel disease in China: A cross-sectional study and meta-analysis

Qi Liang; Bo Qu; Chunye Li; Yue Hu; Chunyi Yang; Tingting Yang; Yuzhu Di; Hui Li

doi:10.2478/fzm-2024-0003

Clinical characteristics and north-south differences of inflammatory bowel disease in China: A cross-sectional study and meta-analysis

doi: 10.2478/fzm-2024-0003

Qi Liang^{1, #},
Bo Qu^{2, #},
Chunye Li³,
Yue Hu¹,
Chunyi Yang¹,
Tingting Yang¹,
Yuzhu Di²,
Hui Li^{2
, ,}

1.
Harbin Medical University, Harbin 150086, China
2.
Digestive Department, the 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China
3.
Huangshi Hospital of Traditional Chinese Medicine, Huangshi 435000, China

Funds:

the Institutional Ethics Committee of The Second Affiliated Hospital of Harbin Medical University KY2021-049

More Information

Corresponding author: Hui Li, E-mail: melanielihui@126.com

摘要

Abstract: Objective This study aimed to estimate the incidence rate and clinical characteristics of inflammatory bowel disease (IBD) in the Chinese population, specially comparing the North and South regions. Methods We designed a questionnaire survey for patients diagnosed with IBD and conducted a systematic literature search in PubMed, China National Knowledge Internet, and Wanfang digital database, covering studies published between 2012 and 2022. Meta-analysis was performed to determine the overall incidence rate and prevalence of clinical manifestations of Crohn's disease (CD) and ulcerative colitis (UC) in mainland China. Clinical phenotypes and demographic characteristics were calculated with 95% confidence intervals (CI). A comparison between the northern and southern regions was also conducted. Results The questionnaire survey included 440 patients, and 64 publications were included for Meta-analysis. The overall incidence rates of IBD, CD, and UC were 1.36 (95% CI: 0.79-2.33) per 100,000 person-years, 0.23 (95% CI: 0.09-0.58) per 100,000 person-years, and 1.12 (95% CI: 0.69-1.80) per 100,000 person-years, respectively. The incidence rates of IBD, CD, and UC were all higher in southern China compared to the North. Clinical characteristics of 440 IBD patients from the questionnaire and 2,821 CD patients and 12,809 UC patients from the literature were analyzed. There were more male patients compared to female patients. CD cases in the North exhibited earlier disease diagnosis (P < 0.01), more upper gastrointestinal lesions (P < 0.01), and higher hospitalizations rates (P < 0.01) compared to the South. UC cases in the North had higher severity (P < 0.01), anemia rates (P < 0.01), and weight loss (P < 0.01) compared to the South. Conclusions The incidence rates of IBD, CD, and UC were higher in southern China than in the North. Northern patients exhibited more severe symptoms compared to their southern counterparts.
- inflammatory bowel disease /
- Crohn's disease /
- ulcerative colitis /
- epidemiology /
- clinical characteristics

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Figure 1. PRISMA flow diagram for literature review.

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Figure 2. The number of IBD cases from publications in each province.

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Figure 3. The prevalence of anemia and weight loss. ^*P < 0.05.

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Table 1. The phenotypic and clinical characteristics of inflammatory bowel disease from the questionnaire (N = 440).

	North (N = 144)	South (N = 296)	P value
Type			< 0.05
UC (N = 216)	85 (59.03)	131 (44.26)
CD (N = 224)	59 (40.97)	165 (55.74)
Gender			> 0.05
Male (N = 260)	79 (54.86)	181 (61.15)
Female (N = 180)	65 (45.14)	115 (38.85)
Age at diagnosis			< 0.05
< 17 years (N = 48)	24 (16.67)	24 (8.11)	< 0.01
17-40 years (N = 300)	88 (61.11)	212 (71.62)	< 0.05
> 40 years (N = 92)	32 (22.22)	60 (20.27)
Education			> 0.05
Secondary or below (N = 221)	77 (53.47)	144 (48.65)
Specialist or Bachelor's degree (N = 205)	64 (44.44)	141 (47.64)
Postgraduate degree and bove (N = 14)	3 (2.08)	11 (3.72)
Smoking			> 0.05
Never (N = 316)	110 (76.39)	206 (69.59)
Ex (N = 87)	23 (15.97)	64 (21.62)
Current (N = 37)	11 (7.64)	26 (8.78)
No. of hospitalizations			> 0.05
1 (N = 307)	92 (63.89)	215 (72.64)
2(N=69)	26 (18.06)	43 (14.53)
3(N=64)	26 (18.06)	38 (12.84)
Extra-intestinal manifestations (N = 127)	49 (34.03)	78 (26.35)	> 0.05
Complications (N = 86)	21 (14.58)	65 (21.96)	> 0.05
Surgical history (N = 93)	18 (12.50)	75 (25.34)	< 0.05
Data were presented as N (%).

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Table 2. The phenotypic and clinical characteristics of Crohn's disease from the questionnaire (N = 224).

	North (N = 59)	South (N = 165)	P value
Gender			> 0.05
Male (N = 152)	40 (67.80)	112 (67.88)
Female (N = 72)	19 (32.20)	53 (32.12)
Age at diagnosis			< 0.01
< 17 years (N = 37)	18 (30.51)	19 (11.52)	< 0.01
17-40 years (N = 160)	32 (54.24)	128 (77.58)	< 0.01
> 40 years (N = 27)	9 (15.25)	18 (10.90)
Education			> 0.05
Secondary or below (N = 116)	36 (61.02)	80 (48.48)
Specialist or Bachelor's degree (N = 102)	23 (38.98)	79 (47.88)
Postgraduate degree and above (N = 6)	0	6 (3.64)	< 0.05
Smoking			> 0.05
Never (N = 159)	44 (74.58)	115 (60.70)
Ex (N = 44)	11 (18.64)	33 (20.00)
Current (N = 21)	4 (6.78)	17 (10.30)
Number of hospitalizations			< 0.05
1 (N = 126)	20 (33.90)	106 (64.24)
2(N=46)	19 (32.20)	27 (16.36)
3(N=52)	20 (33.90)	32 (19.39)
Clinical symptoms
Abdominal pain (N = 65)	16 (27.12)	49 (29.70)	> 0.05
Diarrhoea (N = 154)	36 (61.02)	118 (71.52)	> 0.05
Abdominal mass (N = 36)	11 (18.64)	25 (15.15)	> 0.05
Extra-intestinal manifestations (N = 66)	23 (38.98)	43 (26.06)	> 0.05
Complications (N = 66)	16 (27.12)	50 (30.30)	> 0.05
Surgical history (N = 82)	16 (27.12)	66 (40.00)	> 0.05
Data were presented as N (%).

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Table 3. The phenotypic and clinical characteristics of Crohn's disease from publications.

	North		South		P value
	N (%)	95% CI	N (%)	95% CI
Gender (N = 2304)					> 0.05
Male	233 (63)	0.58-0.68	1232 (64)	0.62-0.66
Female	136 (37)	0.32-0.42	703 (36)	0.34-0.39
Age at diagnosis (N = 1872)					> 0.05
A1	27 (7)	0.05-0.10	176 (12)	0.10-0.14
A2	198 (52)	0.47-0.57	939 (63)	0.61-0.66
A3	159 (41)	0.37-0.46	373 (25)	0.23-0.27
Location (N = 1923)					< 0.01
L1	61 (20)	0.16-0.25	409 (25)	0.23-0.27
L2	63 (20)	0.16-0.26	367 (23)	0.21-0.25
L3	152 (49)	0.45-0.56	780 (48)	0.46-0.50
L4	34 (11)	0.08-0.15	57 (4)	0.03-0.04	< 0.05
Behaviour (N = 937)					> 0.05
B1	164 (55)	0.49-0.60	397 (62)	0.59-0.66
B2	96 (32)	0.27-0.37	158 (25)	0.21-0.28
B3	40 (13)	0.10-0.17	82 (13)	0.10-0.16
Clinical symptoms (N = 1266)
Abdominal pain	79	0.65-0.94	79	0.73-0.85	> 0.05
Diarrhoea	46	0.31-0.61	62	0.49-0.76	> 0.05
Weight loss	47	0.36-0.59	45	0.37-0.53	> 0.05
Fever	37	0.27-0.48	27	0.20-0.34	> 0.05
Extra-intestinal manifestations (N = 1537)	21	0.10-0.31	24	0.17-0.31	> 0.05
Complications (N = 1623)	33	0.15-0.54	33	0.23-0.44	> 0.05
Data were presented as N (%).

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Table 4. The phenotypic and clinical characteristics of ulcerative colitis from the questionnaire.

	North (N = 85)	South (N = 131)	P value
Gender			> 0.05
Male (N = 108)	39 (45.88)	69 (52.67)
Female (N = 108)	46 (54.12)	62 (47.33)
Age at diagnosis			> 0.05
< 17 years (N = 11)	6 (7.06)	5 (3.82)
17-40 years (N = 140)	56 (65.88)	84 (64.12)
> 40 years (N = 65)	23 (27.59)	42 (32.06)
Education			> 0.05
Secondary or below (N = 105)	41 (48.24)	64 (48.85)
Specialist or Bachelor's degree (N = 103)	41 (48.24)	62 (47.33)
Postgraduate degree and above (N = 8)	3 (3.53)	5 (3.82)
Smoking			> 0.05
Never (N = 157)	66 (77.65)	91 (69.47)
Ex (N = 43)	12 (14.12)	31 (23.66)
Current (N = 16)	7 (8.24)	9 (6.87)
Number of hospitalizations			> 0.05
1 (N = 181)	72 (84.71)	109 (83.21)
2(N=23)	7 (8.24)	16 (12.21)
3(N=12)	6 (7.06)	6(4.58)
Location			> 0.05
E1 (N = 60)	26 (30.00)	34 (28.05)
E2 (N = 72)	25 (28.00)	47 (34.15)
E3 (N = 84)	34 (42.00)	50 (37.80)
Clinical symptoms
Abdominal pain (N = 132)	52 (61.18)	80 (61.07)	> 0.05
Diarrhoea (N = 164)	66 (77.65)	98 (74.81)	> 0.05
Abdominal bloating (N = 81)	32 (37.65)	49 (37.40)	> 0.05
Bloody stool (N = 183)	71 (83.53)	112 (85.50)	> 0.05
Mucus (N = 176)	68 (80.00)	108 (82.44)	> 0.05
Fever (N = 48)	27 (31.76)	21 (16.03)	> 0.05
Weight loss (N = 93)	49 (57.65)	44 (33.59)	< 0.05
Anaemia (N = 67)	37 (43.53)	30 (22.90%)	< 0.05
Extra-intestinal manifestations (N = 61)	26 (30.59)	35 (26.72)	> 0.05
Complications (N = 20)	5 (5.88)	15 (11.45)	> 0.05
Surgical history (N = 11)	2 (2.35)	9 (6.87)	> 0.05
Data were presented as N (%).

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Table 5. The phenotypic and clinical characteristics of ulcerative colitis from publications.

	North		South		P value
	N (%)	95% CI	N (%)	95% CI
Gender (N = 12656)					> 0.05
Male	3603 (56)	0.54-0.57	3347 (54)	0.53-0.56
Female	2879 (44)	0.43-0.46	2827 (46)	0.45-0.47
Location (N = 8957)					> 0.05
E1	1531 (39)	0.38-0.41	1016 (20)	0.19-0.21
E2	1510 (39)	0.37-0.40	2179 (43)	0.42-0.44
E3	841 (22)	0.20-0.23	1880 (37)	0.36-0.38
Severity (N = 9475)					< 0.05
Mild	1218 (24)	0.23-0.25	1952 (44)	0.43-0.46
Moderate	2271 (45)	0.44-0.46	1619 (37)	0.35-0.38
Severe	1572 (31)	0.30-0.32	843 (19)	0.18-0.20
Clinical symptoms (N = 8972)
Mucus or bloody tool	81	0.73-0.88	70	0.61-0.79	> 0.05
Diarrhoea	75	0.68-0.81	72	0.62-0.80	> 0.05
Abdominal pain	56	0.48-0.65	63	0.55-0.71	> 0.05
Tenesmus	39	0.27-0.51	27	0.20-0.33	> 0.05
Anaemia	39	0.37-0.41	24	0.22-0.25	< 0.05
Weight loss	36	0.35-0.38	24	0.23-0.26	< 0.05
Fever	25	0.16-0.33	17	0.13-0.21	> 0.05
Extra-intestinal manifestations (N = 7643)	10	0.07-0.14	10	0.08-0.13	> 0.05
Complications (N = 8582)	9	0.06-0.13	12	0.09-0.15	> 0.05
Data were presented as N (%).

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