Increasing Global Burden of Inflammatory Bowel Disease and Its Attributable Anemia in Adults Aged 60 Years and Older: A Comprehensive Analysis of the Global Burden of Disease Study 2021

OBJECTIVE: To quantify the global burden of inflammatory bowel disease (IBD) and IBD-attributable anemia in adults aged ≥ 60 years across 204 countries and territories from 1990 to 2021 and their projected trends through 2045 based on the Global Burden of Disease (GBD) 2021 database. METHODS: Data were extracted from the GBD 2021 database. Age-standardized rates (ASRs) were calculated by age, sex, region, and sociodemographic index (SDI). Joinpoint regression analysis was used to quantify temporal trends. Decomposition analysis assessed drivers of burden change. Concentration index methodology quantified socioeconomic inequalities. And Bayesian age-period-cohort (BAPC) models projected burden through 2045. RESULTS: Prevalent IBD cases among adults aged ≥ 60 years increased by 123% from 573 503 in 1990 to 1 278 194 in 2021, while the age-standardized prevalence rate (ASPR) remained stable. In contrast, the age-standardized incidence rate (ASIR) increased particularly among women (average annual percentage change [AAPC]: 0.31%) than in men (AAPC: 0.26%). IBD-attributable anemia affected 361 157 elder adults in 2021, with a rising ASPR in women. Mortality and disability inequalities widened, with concentration index increasing from 0.07 to 0.23 for mortality and from 0.14 to 0.25 for disability-adjusted life-years (DALYs). By 2045, prevalent cases are projected to reach 2 161 387. CONCLUSIONS: Burdens of IBD and IBD-attributable anemia in adults aged ≥ 60 years have increased substantially, driven predominantly by the demographic expansion of this population. The ASIR continues to rise, particularly among women and in lower-SDI regions, together with widening socioeconomic inequalities, highlighting the need for early diagnosis, anemia screening, frailty assessment, and equitable resource allocation.