Ng, S.C.Kaplan, G.G.Tang, W.Banerjee, R.Adigopula, B.Underwood, F.E.Tanyingoh, D.Wei, S.C.Lin, W.C.Lin, H.H.Li, J.Bell, S.Niewiadomski, O.Kamm, M.A.Zeng, Z.Chen, M.Hu, P.Ong, D.Ooi, C.J.Ling, K. L.Miao, Y.Miao, J.de Silva, H.J.Niriella, M.A.Aniwan, S.Limsrivilai, J.Pisespongsa, P.Wu, K.Yang, H.Ng, K.K.Yu, H. H.Wang, Y.Ouyang, Q.Abdullah, M.Simadibrata, M.Gunawan, J.Hilmi, I.Goh, K. L.Cao, Q.Sheng, H.Ong-Go, A.Chong, V. H.Ching, J. Y. L.Wu, J. C. Y.Chan, F.K.L.Sung, J.J.Y.2019-01-032019-01-032019The American Journal of Gastroenterology. 2019;114(1):107-1150002-9270 (Print)1572-0241 (Electronic)http://repository.kln.ac.lk/handle/123456789/19293Indexed in MEDLINEINTRODUCTION: Living in an urban environment may increase the risk of developing inflammatory bowel disease (IBD). It is unclear if this observation is seen globally. We conducted a population-based study to assess the relationship between urbanization and incidence of IBD in the Asia-Pacific region. METHODS: Newly diagnosed IBD cases between 2011 and 2013 from 13 countries or regions in Asia-Pacific were included. Incidence was calculated with 95% confidence interval (CI) and pooled using random-effects model. Meta-regression analysis was used to assess incidence rates and their association with population density, latitude, and longitude. RESULTS: We identified 1175 ulcerative colitis (UC), 656 Crohn's disease (CD), and 37 IBD undetermined (IBD-U). Mean annual IBD incidence per 100 000 was 1.50 (95% CI: 1.43-1.57). India (9.31; 95% CI: 8.38-10.31) and China (3.64; 95% CI, 2.97-4.42) had the highest IBD incidence in Asia. Incidence of overall IBD (incidence rate ratio [IRR]: 2.19; 95% CI: 1.01-4.76]) and CD (IRR: 3.28; 95% CI: 1.83-9.12) was higher across 19 areas of Asia with a higher population density. In China, incidence of IBD (IRR: 2.37; 95% CI: 1.10-5.16) and UC (IRR: 2.63; 95% CI: 1.2-5.8) was positively associated with gross domestic product. A south-to-north disease gradient (IRR: 0.94; 95% CI: 0.91-0.98) was observed for IBD incidence and a west-to-east gradient (IRR: 1.14; 95% CI: 1.05-1.24) was observed for CD incidence in China. This study received IRB approval. CONCLUSIONS: Regions in Asia with a high population density had a higher CD and UC incidence. Coastal areas within China had higher IBD incidence. With increasing urbanization and a shift from rural areas to cities, disease incidence may continue to climb in Asia.enBowel DiseaseArticle