Disability Burden in IBD

June 16, 2026

Issue 12

Clinical Question

How prevalent is moderate-to-severe disability in patients with inflammatory bowel disease (IBD), and what factors drive it?

Editor’s Bottom Line

Disability remains common among people living with IBD, and slightly more so among those with Crohn’s disease.

Reference

Nardone OM, Calabrese G, Ford AC, et al. Prevalence of disability in inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis. Epub ahead of print March 5, 2026. doi: 10.1093/ibd/izag022.

 

Synopsis

This systematic review and meta-analysis examined the global prevalence of moderate-to-severe disability in patients with IBD. The authors included 17 articles with 7,897 patients across 17 countries included in MEDLINE, Embase, and Embase Classic from inception through 2025. The studies were cross-sectional, cohort, registry-based or case-control studies and all measured disability in adults with confirmed IBD using either the IBD Disability Index (IBD-DI) or the IBD-Disk. Moderate-to-severe disability was defined as an IBD-Disk score ≥40 or an IBD-DI score >30.

The pooled prevalence of moderate-to-severe disability in patients with IBD was 29.6% (95% Confidence Interval [CI], 22.6% to 37.1%), with no evidence of publication bias. When IBD subtypes were analyzed separately, the pooled prevalence of moderate-to-severe disability was higher in Crohn’s disease (CD) (36.9%) than in ulcerative colitis (UC) (30.8%), with an odds ratio (OR) of 1.26 (95% CI, 1.06–1.51) for CD versus UC across four studies that reported data for both types.

The pooled prevalence of moderate-to-severe disability was markedly higher in patients with active IBD (56.9%; 95% CI, 20.3%–89.9%) than in those with inactive disease (27%; 95% CI, 3.3%–62.0%), based on four studies that reported prevalence in both diseases within the same cohort. The pooled OR for moderate-to-severe disability in active versus inactive disease was 3.13 (95% CI, 1.74–5.64). Notably, more than one-quarter of patients in clinical remission still reported moderate-to-severe disability.

In terms of geographical variation, the highest prevalence of moderate-to-severe disability was reported in China (52%; 95% CI, 44.4%–60.1%), followed by Italy (42.4%; 95% CI, 30.9%–54.3%), France (35.4%; 95% CI, 26.9%–44.4%) and Canada (37.4%; 95% CI, 24.9%–50.9%). These were followed by the United States (27.9%), Denmark (26.6%), Australia (21.6%), and Saudi Arabia (19.1%), while the lowest rates were reported in Spain (7.3%) and the Netherlands (7.1%). The authors noted that these differences likely reflect heterogeneity in study populations and settings rather than true geographic variation, and no significant correlation was identified between per capita gross domestic product and disability prevalence.

A comparison of the two disability instruments used found broadly similar estimates: the pooled prevalence of moderate-to-severe disability was 33.3% (95% CI, 21.1%–46.9%) with the IBD-Disk (5 studies; 3,079 patients) and 28.3% (95% CI, 19.1%–38.6%) with the IBD-DI (12 studies; 4,818 patients), supporting the validity of both tools. None of the included studies directly compared the two instruments in the same patient cohort.

 

Details

Study Design: Systematic review and meta-analysis
Funding: No funding source reported
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2a