The shifting burden of early-onset inflammatory bowel disease: a global analysis

BACKGROUND: Early-onset inflammatory bowel disease (EO-IBD), affecting children under age 10 years, has an emerged as a distinct global pediatric health concern with increasing clinical and epidemiological features. Existing data, however, remain insufficient to characterize its full global burden or associated socioeconomic disparities. METHODS: Using Global Burden of Disease 2021 data, we analyzed EO-IBD incidence, mortality, prevalence, and disability-adjusted life years (DALYs) across 204 countries and territories from 1990 to 2021. Decomposition analysis, inequality metrics, and frontier benchmarking were applied to assess temporal trends, cross-national disparities, and burden shifts across levels of Socio-demographic index (SDI). RESULTS: Between 1990 and 2021, global EO-IBD mortality declined by roughly 70%, while incidence remained relatively stable. Prevalence rose, reflecting a growing population of children living with the condition. High-SDI regions recorded the highest incidence but the lowest mortality. Inequality analyses pointed a shifting mortality burden toward lower-SDI populations, and frontier analysis revealed substantial health system performance disparities independent of socioeconomic status. CONCLUSIONS: This comprehensive global assessment of EO-IBD in children reveals diverging mortality and incidence trends alongside persistent socioeconomic inequalities. The findings underscore the urgent need for equitable healthcare access and targeted preventive strategies worldwide, and improved monitoring of pediatric health system equity. IMPACT: Global mortality from early-onset inflammatory bowel disease (EO-IBD) declined by approximately 70% between 1990 and 2021. Despite substantial progress, marked socioeconomic inequalities in EO-IBD mortality persist across regions. This study provides the first comprehensive global assessment of EO-IBD mortality trends and disparities. The findings highlight the need for equitable pediatric IBD care and targeted prevention strategies in resource-limited settings.