Prevalence and patient awareness of inflammatory bowel disease in Kazakhstan: a cross-sectional study

Jamilya Kaibullayeva; Aliya Ualiyeva; Ainash Oshibayeva; Anar Dushpanova; John K. Marshall

doi:10.5217/ir.2019.00099

Articles

Page Path: HOME > Intest Res > Volume 18(4); 2020 > Article

Original Article Inflammatory bowel diseases Prevalence and patient awareness of inflammatory bowel disease in Kazakhstan: a cross-sectional study: Jamilya Kaibullayeva¹, Aliya Ualiyeva^2,3, Ainash Oshibayeva², Anar Dushpanova², John K. Marshall⁴; Intestinal Research 2020;18(4):430-437.
DOI: https://doi.org/10.5217/ir.2019.00099
Published online: September 29, 2020

¹Department of Gastroenterology and Hepatology, Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan

²Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan

³Kazakhstan School of Public Health, Almaty, Kazakhstan

⁴Division of Gastroenterology, McMaster University, Hamilton, ON, Canada

Correspondence to Aliya Ualiyeva, Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Al-Farabi Ave. 71, Almaty 050040, Kazakhstan. Tel: +7-727-377-3333, Fax: +7-727-377-3343, E-mail: aualiyeva9@gmail.com

• Received: August 12, 2019 • Revised: June 24, 2020 • Accepted: June 29, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next

8,798 Views
139 Download
32 Web of Science
34 Crossref
31 Scopus

Full Article

Download PDF

Abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
NOTES
Acknowledgments
REFERENCES

See letter "The first step to unveil the epidemiology of inflammatory bowel disease in Central Asia" in Volume 18 on page 345.

Abstract

Background/Aims
There has been a paucity of published data on the epidemiology of inflammatory bowel disease (IBD) in Central Asia and Kazakhstan. Therefore, we aimed to study IBD prevalence and patient awareness among adults in Kazakhstan.
Methods
The cross-sectional study was carried out among subjects of both sexes aged 18 years and older using IBD Alert Questionnaire (CalproQuest), single fecal calprotectin test, and endoscopy with biopsy to verify IBD from January to December 2017, across regions of Kazakhstan. All participants were included in the study after providing informed consent.
Results
Out of 115,556 subjects, there were 128 confirmed IBD cases, in which 36 Crohn’s disease (CD) and 92 ulcerative colitis (UC) cases identified. The age and sex-adjusted IBD prevalence were 113.9 (95% confidence interval [CI], 69.0–158.9) per 100,000 population. The age- and sex-adjusted prevalence for UC were 84.4 (95% CI, 44.8–123.9) and for CD were 29.5 (95% CI, 8.2–50.9) per 100,000 population.
Conclusions
This is the first report on the prevalence of IBD with a verified diagnosis in the Central Asia and could be used to better plan and allocate healthcare resources for IBD management program.
Keywords: Inflammatory bowel diseases; Prevalence; Kazakhstan

INTRODUCTION

Having an early onset and chronic course, inflammatory bowel disease (IBD) significantly reduces quality of life and increases permanent disability resulting in a heavy burden to patients, their families and healthcare systems [1-4]. Historically, IBD was mainly considered as a disease of the Westernized countries; it has become a global disease spreading in many Asian, African and South American countries [5]. The Ministry of Health of Kazakhstan (MoH) reported that the prevalence of Crohn’s disease (CD) and ulcerative colitis (UC) was 6.3 and 31.5 per 100,000 populations, respectively [6]. However, due to the lack of relevant databases and registries on IBD in Kazakhstan, this prevalence was reported based on the number of hospital admissions, which underestimates the true prevalence of the disease. Despite this fact, there has been a paucity of published data on the epidemiology of IBD in Central Asia and Kazakhstan. Therefore, we aimed to study IBD prevalence and patient awareness among adults in Kazakhstan.

METHODS

1. Study Design and Subjects

This cross-sectional study was carried out among subjects of both sexes aged 18 years and older using IBD Alert Questionnaire (CalproQuest) [7] from January 1 to December 31, 2017, across regions of Kazakhstan. IBD Alert Questionnaire has been tested and found practicable in primary care [8]. The questionnaires were distributed both electronically and in hard copy (details below). At the first stage, we sent the questionnaire contained introductory information about the study, and a consent to participate in the first stage of the study. Next, participants who advanced to the second stage (fecal calprotectin [FCAL] testing) signed informed consent for the remainder of the study. The Ethics Committee of the Kazakh Research Institute of Cardiology and Internal Medicine approved the study protocol (approval No. #4, 21.09.2016).

2. Case Identification

IBD case identification was done by the following steps. The first step consisted of an active IBD case identification among the adult population through the questionnaire proposed by Hasler et al. [7,8]. The second step was the examination of the suspected cases with positive symptoms by a qualified gastroenterologist who also performed a FCAL test [9] by a semi-quantitative method (PreventID^® CalDetect^® 50/200; Preventis GmbH, Bensheim, Germany). Next, we verified diagnosis among positive calprotectin cases (calprotectin concentration ≥ 50 µg/g). The IBD diagnosis was finally established based on clinical, endoscopic and histological criteria under the Kazakhstani protocol of diagnosis and treatment and the European consensus on the diagnosis and management of UC and CD [10,11].

3. Data Collection

Before data collection, the official information letter, which describes study goals, methods, and participant confidentiality protection as well as request permission for the survey, had been sent to the administration of each institution such as companies, universities, polyclinics located across the regions of Kazakhstan. After receiving permission, the interviewers surveyed subjects using a complete coverage method. We calculated the minimum required sample size of 99,174 respondents assuming low prevalence of the disease [6] based on the number of adult population from the Kazakhstan census and sample size calculation method [12] to estimate the prevalence with good precision.

Researchers have distributed 135,000 questionnaires considering potential loss during the distribution and collection process. The total number of correctly completed questionnaires was 115,556 (85.6%).

Specifically, the questionnaires distributed in the universities involved all 2nd- and 3rd-year undergraduate students and master’s students. Each region was represented by one university. Likewise, the questionnaires were carried out among office, factory and plant workers. We also recruited general physicians who assisted in completing questionnaires in their communities. During the survey, the interviewers recorded response and explained the questions if respondents needed. To prevent subjects from being sampled twice, we conducted a survey in each organization once as well as included questions on contact information to communicate with a suspected duplicate subject if needed.

We used Mayo score [13] and Crohn’s Disease Activity Index [14] to assess the UC and CD severity levels and the Montreal classification to describe the disease phenotype [15].

Cases were also defined based on IBD awareness status, stool frequency (times/day), need for steroids treatment, having a history of gastrointestinal surgery (colectomy, small bowel resection, and appendectomy) due to IBD, blood in the stool, abdominal pain, perianal disease, abdominal infiltrate based on ultrasound or palpation findings, aphthae in the oral cavity, skin manifestations (erythema nodosum, gangrenous pyoderma) and comorbidities such as musculoskeletal system (arthralgia, arthritis; ankylosing spondylitis, sacroiliitis; granulomatous myositis), and hepatobiliary system (liver steatosis, gallstone disease, biliary cirrhosis, primary sclerosing cholangitis, hepatitis and cirrhosis); having subfebrile fever was defined when body temperature was higher than 37°C.

4. Statistical Analysis

We reported a mean and standard deviation for continuous variables and frequencies, and percentages for categorical variables. Prevalence and 95% confidence intervals (CIs) were calculated based on the Wald method modified by the Agresti-Coull method [16]. The prevalence of IBD by region is represented by crude and adjusted methods of direct standardization by age and sex indicators [17]. Associations between IBD and age, sex, place of residence, and clinical characteristics were assessed by using two-tailed Fisher exact test and Pearson chi-square test. Since the variables “age” and “body mass index” were categorized, the two-tailed Fisher exact test and Pearson chi-square test were used to study the associations of these indicators with IBD. A P-value of less than 0.05 was considered statistically significant. Statistical analysis was performed by using IBM SPSS Statistics software version 19.0 (IBM Corp., Armonk, NY, USA).

RESULTS

1. Prevalence of IBD

Out of 115,556 subjects, there were 128 confirmed IBD cases, in which 36 CD cases and 92 UC cases identified. The age and sex-adjusted IBD prevalence were 113.9 (95% CI, 69.0–158.9) per 100,000 population. The age- and sex-adjusted prevalence for UC were 84.4 (95% CI, 44.8–123.9) and for CD were 29.5 (95% CI, 8.2–50.9) per 100,000 population (Fig. 1). The overall mean ± standard deviation age was 44.2 ± 15.1 years, 36.1% were males and 63.9% were females. Demographic characteristics are described in Table 1. The overall response rate was 86.5%, in which polyclinic participants accounted for 57.5%, 11.0% of students, and 31.5% of workers from various institutions. Specifically, the response rates in polyclinics, universities and works were 83.6%, 92.4%, and 90.2% respectively.

The highest IBD prevalence was in the age group of 30 to 39 years, which was similar to the UC age pattern. In contrast, the CD cases were more prevalent at younger age adults. Overall, IBD was more prevalent in males than females, but the CD was present more in females. The urban population has a higher IBD prevalence than the rural population. The difference in prevalence of IBD and its types across age, sex and geographical location are shown in Table 2.

The eastern region had the highest age- and sex-adjusted prevalence of IBD in Kazakhstan; whereas; the south region had the lowest rate (126.5 [95% CI, 15.4–237.6] and 87.7 [95% CI, 0–176.2] per 100,000, respectively). The age- and sex-adjusted prevalence of UC was the highest in the eastern region and the lowest was in Almaty and western region (108.2 [95% CI, 3.6–212.9], 72.4 [95% CI, 9.4–135.5], and 72.5 [95% CI, 0–190.7] per 100,000, respectively). In contrast, the highest age- and sex-adjusted prevalence of CD was seen in Almaty and the lowest rate was in the southern region (48.7 [95% CI, 0–98.2] and 6.6 [95% CI, 0–35.5] per 100,000, respectively). The difference in the prevalence of IBD and its types across regions is shown in Table 3.

2. Impact of Demographic and Clinical Characteristics on IBD Awareness

Out of 128 identified IBD cases, 25 cases (19.5%) were unaware of their diagnosis. Among these unaware subjects, 16 cases (64%) had UC and 9 (36%) had CD.

Most patients with UC had left side colitis (44.6%), while patient with CD had cases of ileal location (41.7%) and ileocolonic disease (38.9%) (Table 4).

Table 5 indicates that demographic characteristics such as age, sex and geographical location were not statistically associated with IBD awareness status.

Stool frequency and hepatobiliary system disorders were significantly associated with previous IBD awareness status (Table 6).

DISCUSSION

To our knowledge, this is the first report on IBD prevalence among adults in Kazakhstan with verified diagnoses. We found that the age- and sex-adjusted IBD prevalence was 110.8 (95% CI, 91.5–130.1) per 100,000 population, with UC more prevalent than CD (79.6 [95% CI, 63.2–96.1] per 100,000 population vs. 31.2 [95% CI, 20.7–41.6] per 100,000 population, respectively). Our estimated prevalence rates are much higher than those reported by the MoH, which are 31.5 per 100,000 population for UC and 6.3 per 100,000 population for CD [6]. This inconsistency with the MoH could be explained by the different database system where MoH uses the hospital-based data that counts only the number of hospitalized IBD patients and misses many undetected cases. Another explanation could be in limited access to gastroenterological care, especially in rural areas, resulting in under detection of cases. The primary care settings that have a low index of suspicion for IBD, especially for CD, distinguished by the variety of symptoms might also be a reason for under detection of IBD cases. Our findings were closed to what we expected, being in the prevalence range between Western and Eastern Asian countries [5]. A recently published systematic review on the global epidemiology of IBD also supports rising IBD incidence in the newly industrialized countries [5]. In general, the situation concerning the IBD prevalence in Asian countries is very similar to a West-East gradient of 2:1 in IBD incidence in Europe [18], but with lower rates. An epidemiological study in Russia, for example, found that its European part had 20.4 per 100,000 population for UC and 3.7 per 100,000 population for CD [19]. In one hand, the observed prevalence could partially be explained by the differences in healthcare access, database system, lifestyle and various risk factors as reported previously [20,21]. Another possible explanation might be that Central Asian, including Kazakhstan, has a traditional nomadic diet, which may lie somewhere between West and East Asian cuisines, resulting in intermediate prevalence rates.

In our study, the highest prevalence for UC was observed at the age group 30 to 39 years; and CD was more prevalent among younger adults. This observed age pattern was not consistent with the literature [2]. Usually, most chronic diseases with low mortality as in the case of IBD tend to be more prevalent in older age groups, having the highest prevalence over 50 years old [22]. Higher IBD prevalence rates at young age groups in this study partially could be associated with an increase in the IBD incidence in Kazakhstan in the last 20 to 30 years due to the changes in diet [23], urbanization [24] and improved gastroenterological care as well as an increased health awareness among population.

We also determined that males had more UC prevalence; whereas, females had more CD cases. Our findings match those observed in earlier studies [25-27]. CD is more prevalent among females, while in population-based studies of UC no significant differences were observed [25].

In our study, a slight predominance of IBD prevalence was observed in the urban population. This further supports the idea of an association between IBD and the growth of urbanization [20,28]. We also think that these results are likely to be related to the poorer quality and limited access to healthcare services, especially gastroenterology care, and health literacy, being better in cities than in rural areas.

Although IBD was prevalent across Kazakhstan, it has been disproportionately distributed in it. The eastern region had the highest prevalence and the southern region had the least prevalence. This regional heterogeneity might be due to the environmental factors. For example, the eastern region is the most industrially developed region, so it is possible that people are more likely to be exposed to potential health hazards resulting in an increased IBD incidence. Evidence from literature review demonstrates the relationship between environmental risk factors and IBD development [29], supporting our speculations.

Interestingly, almost one-fifth of IBD cases were unaware of their disease status. Stool frequency and hepatobiliary system disorders were signaling reasons to seek for medical care. It is possible that these unaware cases did not know about their disease due to the low IBD activity and poor health literacy that were supported by the findings.

This could suggest that there may be more undetected IBD cases that are at a higher risk for developing negative outcomes [30].

Several limitations of this study must be noted. The main limitation is that this study had a non-random sample, having a potential for the selection bias and underestimating the true IBD prevalence. In fact, we may have surveyed a relatively healthy population who can socialize by attending school, work and visiting general physicians. Since IBD could hugely impact on patients’ quality of life making them not to perform daily activities as mentioned above [3,4], the moderate to relatively severe IBD cases might not be captured in this study. However, to overcome these challenges and identify as many IBD cases as possible from the general population, we used an active case identification strategy, including colonoscopy with biopsy, the gold standard for IBD diagnosis as reported previously [7,8,31]. Moreover, we involved general physicians who can also have a piece of good knowledge about diagnosed and suspected IBD cases in their communities. Another limitation is since the large geographical spread of rural areas in Kazakhstan, unavailability of appropriate gastroenterological care in it and the limited financial resources, rural residents were partially underrepresented, specifically remote rural residents. Yet we surveyed those rural residents who were living close to the cities and tried to cover as far as we could access them.

In our study, the single FCAL demonstrated a sensitivity of 100% (97.2–100), specificity of 85.3% (81.2–88.8), positive predicted value of 70.7% (65.3–75.6), and negative predicted value of 100%. However, we should be cautious about a high diagnostic accuracy of the used test in our study and admit its limitation in determining who should be referring for invasive procedures to verify the IBD diagnosis. The FCAL test is concentration-sensitive, so the sensitivity and specificity of the test could vary based on the used threshold, which has its advantages and disadvantages [9,32-34]. Furthermore, since we used a single FCAL test and did not investigate further negative FCAL cases for IBD present to rule out the diagnosis, we could miss a few IBD cases. Therefore, the single FCAL test diagnostic accuracy could be overestimated in our study. Likewise, the usage of the single FCAL test might miss a few true cases but it could prevent many people from unnecessary costly invasive procedures and patient discomfort [34].

This is the first report on the prevalence of IBD with a verified diagnosis in Central Asia. The age- and sex-adjusted prevalence of UC was 84.4 (95% CI, 44.8–123.9) per 100,000 population and CD was 29.5 (95% CI, 8.2–50.9) per 100,000 population. The results could be used for politicians, clinicians and public health practitioners to better plan and allocate health resources on IBD prevention and treatment programs. Furthermore, Kazakhstan holds an intermediate position between East and West Asia, with diet and lifestyle traditions similar to other Central Asian countries. Therefore, the epidemiology of IBD in Kazakhstan could be used as a proxy for its prevalence throughout Central Asia to fulfill gaps in knowledge of the burden of IBD in the region.

NOTES

FINANCIAL SUPPORT

The study was conducted with the financial support of the EGIS Pharmaceuticals PLC Representative office in Kazakhstan and Takeda Pharmaceutical Company Limited.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

AUTHOR CONTRIBUTION

Study design: Kaibullayeva J, Ualiyeva A, Oshibayeva A. Data collection: Kaibullayeva J, Ualiyeva A, Oshibayeva A, Dushpanova A. Data analysis: Kaibullayeva J, Ualiyeva A, Oshibayeva A. Discussion of results: Kaibullayeva J, Ualiyeva A, Oshibayeva A, Marshall JK. Writing the manuscript: all authors. Approval of final manuscript: all authors.

Acknowledgments

Funding was used to develop and distribute questionnaires, to cover expenses related to patients’ physical exams and lab tests and doctor counseling.

We thank Dr. Alibek Mereke for his comments that strengthened the manuscript.

Fig. 1.

Steps for inflammatory bowel disease (IBD) case identification.

Table 1.

Demographic Characteristics of the Study Participants

Characteristics	Value (n = 115,556)
Age (yr)	44.2 ± 15.1
Age group (yr)
18–29	24,707 (21.4)
30–39	21,224 (18.4)
40–49	21,364 (18.5)
50–59	27,973 (24.2)
≥ 60	20,288 (17.6)
Sex
Male	41,708 (36.1)
Female	73,848 (63.9)
Area
Urban	92,908 (80.4)
Rural	22,648 (19.6)
Region
Almaty	37,444 (32.4)
East	25,332 (21.9)
West	11,108 (9.6)
North	29,107 (25.2)
South	12,565 (10.9)

Values are presented as mean±standard deviation or number (%).

Table 2.

Prevalence of IBD and Its Types across Age, Sex and Geographical Location in Kazakhstan

Characteristics	IBD		UC		CD
Characteristics	Per 100,000	95% CI	Per 100,000	95% CI	Per 100,000	95% CI
Age group (yr)
18–29	129.5	83.3–175.7	89.0	50.2–127.9	40.5	13.0–67.9
30–39	155.5	100.9–210.1	117.8	69.8–165.7	37.7	8.5–66.9
40–49	117.0	69.4–164.7	74.9	36.0–113.8	42.1	11.7–72.5
50–59	75.1	41.5–108.7	53.6	24.7–82.5	21.4	1.6–41.3
≥ 60	83.8	41.7–125.9	69.0	30.4–107.6	14.8	0–36.4
Total	110.8	91.5–130.1	79.6	63.2–96.1	31.2	20.7–41.6
Sex
Male	129.5	94.3–164.6	107.9	75.7–140.1	21.6	6.0–37.2
Female	100.2	77.1–123.3	63.6	45.1–82.2	36.6	22.3–50.9
Area
Urban	114.1	92.2–136.0	81.8	63.2–100.4	32.3	20.4–44.2
Rural	97.1	54.8–139.5	70.6	33.9–107.3	26.5	2.0–51.0

IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease; CI, confidence interval.

Table 3.

Prevalence of IBD and Its Types by Regions

Region	IBD		UC		CD
Region	Per 100,000	95% CI	Per 100,000	95% CI	Per 100,000	95% CI
Crude rates
Almaty	120.2	84.3–156.1	72.1	43.9–100.3	48.1	24.7–71.5
East	114.5	71.5–157.5	94.7	55.3–134.2	19.7	0–40.2
West	108.0	42.0–174.0	72.0	16.3–127.8	36.0	0–79.2
North	106.5	67.8–145.2	79.0	45.4–112.7	27.5	6.2–48.8
South	87.5	31.3–143.7	79.6	25.6–133.6	8.0	0–35.0
Total	110.8	91.5–130.1	79.6	63.2–96.1	31.2	20.7–41.6
Age/sex-adjusted rates
Almaty	121.1	41.0–201.3	72.4	9.4–135.5	48.7	0–98.2
East	126.5	15.4–237.6	108.2	3.6–212.9	18.3	0–55.5
West	102.4	0–235.3	72.5	0–190.7	29.9	0–90.5
North	109.4	20.7–198.1	84.9	4.6–165.3	24.5	0–62.0
South	87.7	0–176.2	81.1	0–164.8	6.6	0–35.5
Total	113.9	69.0–158.9	84.4	44.8–123.9	29.5	8.2–50.9

IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease; CI, confidence interval.

Table 4.

Clinical Characteristics of IBD-Based on the Montreal Classification

Localization	No. (%)
UC (n = 92)
Extent
E1 (proctitis)	30 (32.6)
E2 (left side colitis)	41 (44.6)
E3 (pancolitis)	21 (22.8)
Severity
S1 (mild UC)	21 (22.8)
S2 (moderate UC)	47 (51.1)
S3 (severe UC)	24 (26.1)
CD (n=36)
Location
L1 (ileal)	15 (41.7)
L2 (colonic)	7 (19.4)
L3 (ileocolonic)	14 (38.9)
Behavior
B1 (non-stricturing, non-penetrating)	20 (55.6)
B2 (structuring)	14 (38.9)
B3 (penetrating)	2 (5.6)
p (perianal disease modifier)	1 (2.8)

IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease.

Table 5.

An Association between Inflammatory Bowel Disease Awareness Status and Demographic Characteristics

Characteristics	Unaware (n=25)	Aware (n=103)	P-value^a
Sex			0.121
Male	7 (28)	47 (45.6)
Female	18 (72)	56 (54.4)
Age (yr)			0.187
18–40 (A2)	16 (64)	50 (48.5)
> 40 (A3)	9 (36)	53 (51.5)
Area			0.943
Urban	19 (76)	75 (72.8)
Rural	6 (24)	28 (27.2)

Values are presented as number (%).

^a Fisher exact test.

Table 6.

An Association between IBD Awareness Status and Clinical Manifestations

Characteristics	Unaware (n=25)	Aware (n=103)	P-value
IBD type			0.332^a
UC	16 (64)	76 (73.8)
CD	9 (36)	27 (26.2)
Stool frequency, time/day			< 0.001
<5	23 (92)	49 (47.6)
6–10	2 (8)	37 (35.9)
> 10	0 (0)	17 (16.5)
Requires steroids treatment (yes)	9 (37.5)	42 (48.3)	0.367^a
History of GIT surgery due to IBD (yes)	2 (8)	12 (11.7)	0.867^b
Blood in stool (yes)	7 (28)	26 (25.2)	0.801^a
Abdominal pain (yes)	8 (32)	19 (18.4)	0.171^a
Subfebrile fever (yes)	10 (40)	33 (32.0)	0.487^a
Perianal disease (yes)	2 (8)	22 (21.4)	0.159^b
Aphthae (yes)	5 (20)	23 (22.3)	1.000^a
Abdominal infiltrate (yes)	3 (12)	8 (7.8)	0.448^b
Skin disorders (yes)	4 (16)	8 (7.8)	0.248^b
Musculoskeletal disorders (yes)	11 (44)	58 (56.3)	0.371^a
Hepatobiliary system disorders (yes)	2 (8)	33 (32.0)	0.022^b
BMI (kg/m²)			0.243^a
< 18.5	2 (8)	11 (10.7)
18.5–24.99	16 (64)	68 (66.0)
25–30	7 (28)	18 (17.5)
>30	0	6 (5.8)

^a Chi-square test.

^b Fisher exact test.

IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease; GIT, gastrointestinal tract; BMI, body mass index.

REFERENCES

1. Longobardi T, Jacobs P, Bernstein CN. Work losses related to inflammatory bowel disease in the United States: results from the National Health Interview Survey. Am J Gastroenterol 2003;98:1064–1072.Article PubMed
2. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 2011;140:1785–1794.Article PubMed
3. Anderson A, Click B, Ramos-Rivers C, et al. The association between sustained poor quality of life and future opioid use in inflammatory bowel disease. Inflamm Bowel Dis 2018;24:1380–1388.Article PubMed PMC PDF
4. Graff LA, Walker JR, Lix L, et al. The relationship of inflammatory bowel disease type and activity to psychological functioning and quality of life. Clin Gastroenterol Hepatol 2006;4:1491–1501.Article PubMed
5. Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 2018;390:2769–2778.Article
6. Results of the II National Forum on the IBD. Kazakhstan Pharmaceutical Bulletin Web site http://pharmnews.kz/ru/article/itogi-ii-nacionalnogo-foruma-po-vzk_13762. Updated June 8, 2018. Accessed April 16, 2019.
7. Hasler S, Zahnd N, Müller S, et al. VAlidation of an 8-item-questionnaire predictive for a positive calprotectin tEst and Real-life implemenTation in primary care to reduce diagnostic delay in inflammatory bowel disease (ALERT): protocol for a prospective diagnostic study. BMJ Open 2015;5:e007306.Article PubMed PMC
8. Chmiel C, Vavricka SR, Hasler S, et al. Feasibility of an 8-item questionnaire for early diagnosis of inflammatory bowel disease in primary care. J Eval Clin Pract 2019;25:155–162.Article PubMed
9. Hessels J, Douw G, Yildirim DD, Meerman G, van Herwaarden MA, van den Bergh FA. Evaluation of Prevent ID and Quantum Blue rapid tests for fecal calprotectin. Clin Chem Lab Med 2012;50:1079–1082.Article PubMed PDF
10. Gomollón F, Dignass A, Annese V, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis 2017;11:3–25.Article PubMed PDF
11. Magro F, Gionchetti P, Eliakim R, et al. Third european evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis 2017;11:649–670.Article PubMed PDF
12. Daniel WW, Cross CL. Biostatistics: a foundation for analysis in the health sciences. 7th ed. New York: John Wiley & Sons, 1999.
13. Lewis JD, Chuai S, Nessel L, Lichtenstein GR, Aberra FN, Ellenberg JH. Use of the noninvasive components of the Mayo score to assess clinical response in ulcerative colitis. Inflamm Bowel Dis 2008;14:1660–1666.Article PubMed PMC
14. Freeman HJ. Use of the Crohn’s disease activity index in clinical trials of biological agents. World J Gastroenterol 2008;14:4127–4130.Article PubMed PMC
15. Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006;55:749–753.Article PubMed
16. Agresti A, Coull BA. Approximate is better than “exact” for interval estimation of binomial proportions. Am Stat 1998;52:119–126.Article
17. Bains N. Standardization of rates. Association of Public Health Epidemiologists in Ontario Web site http://core.apheo.ca/resources/indicators/Standardization%20report_NamBains_FINALMarch16.pdf. Updated 2009. Accessed May 2, 2017.
18. Burisch J, Pedersen N, Čuković-Čavka S, et al. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 2014;63:588–597.Article PubMed
19. Belousova EA, Abdulganieva DI, Alexeeva OP, et al. Social and demographic characteristics, features of disease course and treatment options of inflammatory bowel disease in Russia: results of two multicenter studies. Almanac Clin Med 2018;46:445–463.Article
20. Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol 2015;12:720–727.Article PubMed PDF
21. Kaplan GG, Ng SC. Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology 2017;152:313–321.Article PubMed
22. Kappelman MD, Rifas-Shiman SL, Kleinman K, et al. The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol 2007;5:1424–1429.Article PubMed
23. NCD Risk Factor Collaboration (NCD-RisC). Rising rural bodymass index is the main driver of the global obesity epidemic in adults. Nature 2019;569:260–264.Article PubMed PMC
24. Soon IS, Molodecky NA, Rabi DM, Ghali WA, Barkema HW, Kaplan GG. The relationship between urban environment and the inflammatory bowel diseases: a systematic review and meta-analysis. BMC Gastroenterol 2012;12:51.Article PubMed PMC
25. Bernstein CN, Blanchard JF, Rawsthorne P, Wajda A. Epidemiology of Crohn’s disease and ulcerative colitis in a central Canadian province: a population-based study. Am J Epidemiol 1999;149:916–924.Article PubMed PDF
26. Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn’s disease in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival. Gastroenterology 1998;114:1161–1168.Article PubMed
27. Molinié F, Gower-Rousseau C, Yzet T, et al. Opposite evolution in incidence of Crohn’s disease and ulcerative colitis in Northern France (1988-1999). Gut 2004;53:843–848.Article PubMed PMC
28. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012;142:46–54.Article PubMed
29. Abegunde AT, Muhammad BH, Bhatti O, Ali T. Environmental risk factors for inflammatory bowel diseases: evidence based literature review. World J Gastroenterol 2016;22:6296–6317.Article PubMed PMC
30. Winther KV, Jess T, Langholz E, Munkholm P, Binder V. Survival and cause-specific mortality in ulcerative colitis: follow-up of a population-based cohort in Copenhagen County. Gastroenterology 2003;125:1576–1582.Article PubMed
31. Burri E, Beglinger C. Faecal calprotectin in the diagnosis of inflammatory bowel disease. Biochem Med (Zagreb) 2011;21:245–253.Article PubMed
32. Puolanne AM, Kolho KL, Alfthan H, Ristimäki A, Mustonen H, Färkkilä M. Rapid faecal tests for detecting disease activity in colonic inflammatory bowel disease. Eur J Clin Invest 2016;46:825–832.Article PubMed
33. Brookes MJ, Whitehead S, Gaya DR, Hawthorne AB. Practical guidance on the use of faecal calprotectin. Frontline Gastroenterol 2018;9:87–91.Article PubMed
34. Laserna-Mendieta EJ, Lucendo AJ. Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations. Clin Chem Lab Med 2019;57:1295–1307.Article PubMed PDF

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

A review investigating delays in Crohn's disease diagnosis
Christophe Souaid, Eddy Fares, Paul Primard, Gilles Macaigne, Weam El Hajj, Stephane Nahon
Clinics and Research in Hepatology and Gastroenterology.2025; 49(1): 102500. CrossRef
A systematic review of inflammatory bowel disease in Kazakhstan: prevalence, risk factors, and genetic insights
Aigerim Japparkulova, Ainash Oshibayeva, Gulnaz Nuskabayeva, Karlygash Sadykova, Jamilya Kaibullayeva, Nursultan Nurdinov
Future Science OA.2025;[Epub] CrossRef
Awareness of inflammatory bowel disease among the general population of Al-Baha region, Saudi Arabia
Turki Alkully, Sarah Taishan, Wafaa Taishan, Lara Alsakka, Njood Alghamdi, Nouf Alghamdi, Mohammed Alghamdi
Journal of Medicine and Life.2024; 17(2): 164. CrossRef
Capsule endoscopy in Kazakhstan: a multicenter clinical experience
Sang Jun Sohn, Kanat Batyrbekov, Ainura Galiakbarova, Laura Yerdaliyeva, Jamilya Kaibullayeva, Jeongwoo Ju, Haejin Lee, Yeoun Joo Lee
Kosin Medical Journal.2024; 39(3): 179. CrossRef
Systematic review with meta‐analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease
Nishani Jayasooriya, Samantha Baillie, Jonathan Blackwell, Alex Bottle, Irene Petersen, Hanna Creese, Sonia Saxena, Richard C. Pollok
Alimentary Pharmacology & Therapeutics.2023; 57(6): 635. CrossRef
Impact of Sarcopenia on Clinical Course of Inflammatory Bowel Disease in Korea
Kwangwoo Nam, Jae Yong Lee, Yousun Ko, Kyung Won Kim, Ho-Su Lee, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byoun, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park
Digestive Diseases and Sciences.2023; 68(6): 2165. CrossRef
Real-world effectiveness and safety of ustekinumab induction therapy for Korean patients with Crohn’s disease: a KASID prospective multicenter study
Kyunghwan Oh, Hee Seung Hong, Nam Seok Ham, Jungbok Lee, Sang Hyoung Park, Suk-Kyun Yang, Hyuk Yoon, You Sun Kim, Chang Hwan Choi, Byong Duk Ye
Intestinal Research.2023; 21(1): 137. CrossRef
Obesity and novel management of inflammatory bowel disease
Jee Hyun Kim, Chang-Myung Oh, Jun Hwan Yoo
World Journal of Gastroenterology.2023; 29(12): 1779. CrossRef
Bronchoesophageal fistula in a patient with Crohn’s disease receiving anti-tumor necrosis factor therapy
Kyunghwan Oh, Kee Don Choi, Hyeong Ryul Kim, Tae Sun Shim, Byong Duk Ye, Suk-Kyun Yang, Sang Hyoung Park
Clinical Endoscopy.2023; 56(2): 239. CrossRef
Evolving Trends and Burden of Inflammatory Bowel Disease in Asia, 1990–2019: A Comprehensive Analysis Based on the Global Burden of Disease Study
Xuejie Chen, Xin Xiang, Weitong Xia, Xindi Li, Sidan Wang, Shuyu Ye, Li Tian, Lian Zhao, Feiyan Ai, Zhaohua Shen, Kai Nie, Minzi Deng, Xiaoyan Wang
Journal of Epidemiology and Global Health.2023; 13(4): 725. CrossRef
Combined Endoscopic and Radiologic Healing Is Associated With a Better Prognosis Than Endoscopic Healing Only in Patients With Crohn's Disease Receiving Anti-TNF Therapy
Kyunghwan Oh, Eun Hye Oh, Soo Min Noh, Seong Ho Park, Nayoung Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Byong Duk Ye
Clinical and Translational Gastroenterology.2022; 13(1): e00442. CrossRef
Changes in the Long-term Prognosis of Crohn’s Disease between 1986 and 2015: The Population-Based Songpa-Kangdong Inflammatory Bowel Disease Cohort Study
Byong Duk Ye, Sung Noh Hong, Seung In Seo, Ye-Jee Kim, Jae Myung Cha, Kyoung Hoon Rhee, Hyuk Yoon, Young-Ho Kim, Kyung Ho Kim, Sun Yong Park, Seung Kyu Jeong, Ji Hyun Lee, Hyunju Park, Joo Sung Kim, Jong Pil Im, Sung Hoon Kim, Jisun Jang, Jeong Hwan Kim,
Gut and Liver.2022; 16(2): 216. CrossRef
Update on the epidemiology of inflammatory bowel disease in Asia: where are we now?
Sang Hyoung Park
Intestinal Research.2022; 20(2): 159. CrossRef
Fecal S100A12 is associated with future hospitalization and step-up of medical treatment in patients with Crohn’s disease in clinical remission: a pilot study
Sun-Ho Lee, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Byong Duk Ye
Intestinal Research.2022; 20(2): 203. CrossRef
Clinical Course of Hepatitis B Viral Infection in Patients Undergoing Anti-Tumor Necrosis Factor α Therapy for Inflammatory Bowel Disease
Ji Min Lee, Shu-Chen Wei, Kang-Moon Lee, Byong Duk Ye, Ren Mao, Hyun-Soo Kim, Soo Jung Park, Sang Hyoung Park, Eun Hye Oh, Jong Pil Im, Byung Ik Jang, Dae Bum Kim, Ken Takeuchi
Gut and Liver.2022; 16(3): 396. CrossRef
Personalized medicine in inflammatory bowel disease: Perspectives on Asia
Su Hyun Park, Sang Hyoung Park
Journal of Gastroenterology and Hepatology.2022; 37(8): 1434. CrossRef
Medication Adherence in Korean Patients with Inflammatory Bowel Disease and Its Associated Factors
Kyunghwan Oh, Eun Ja Kwon, Jeong Hye Kim, Kyuwon Kim, Jae Yong Lee, Hee Seung Hong, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jeong Yun Park, Sang Hyoung Park
The Ewha Medical Journal.2022; 45(2): 35. CrossRef
Evaluation of nutritional status using bioelectrical impedance analysis in patients with inflammatory bowel disease
Seung Hyuk Kim, You Sun Kim, Si Hyeong Lee, Hyun Mi Lee, Won Eui Yoon, Seo Hyun Kim, Hee Jun Myung, Jeong Seop Moon
Intestinal Research.2022; 20(3): 321. CrossRef
Oral beclomethasone dipropionate as an add-on therapy and response prediction in Korean patients with ulcerative colitis
Kyuwon Kim, Hee Seung Hong, Kyunghwan Oh, Jae Yong Lee, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Byong Duk Ye, Sang Hyoung Park
The Korean Journal of Internal Medicine.2022; 37(6): 1140. CrossRef
Inflammatory bowel disease in Korea: epidemiology and pathophysiology
Jung Won Lee, Chang Soo Eun
The Korean Journal of Internal Medicine.2022; 37(5): 885. CrossRef
Management of inflammatory bowel disease beyond tumor necrosis factor inhibitors: novel biologics and small-molecule drugs
Soo-Young Na, You Sun Kim
The Korean Journal of Internal Medicine.2022; 37(5): 906. CrossRef
What Are the Different Phenotypes of Inflammatory Bowel Disease in Asia?
Su Bee Park, Jin Young Yoon, Jae Myung Cha
Gut and Liver.2022; 16(5): 676. CrossRef
Natural history of inflammatory bowel disease: a comparison between the East and the West
Eun Mi Song, Suk-Kyun Yang
Intestinal Research.2022; 20(4): 418. CrossRef
Clinical Features and Long-term Prognosis of Crohn’s Disease in Korea: Results from the Prospective CONNECT Study
Seung Wook Hong, Byong Duk Ye, Jae Hee Cheon, Ji Hyun Lee, Ja Seol Koo, Byung Ik Jang, Kang-Moon Lee, You Sun Kim, Tae Oh Kim, Jong Pil Im, Geun Am Song, Sung-Ae Jung, Hyun Soo Kim, Dong Il Park, Hyun-Soo Kim, Kyu Chan Huh, Young-Ho Kim, Jae Myung Cha, Ge
Gut and Liver.2022; 16(6): 907. CrossRef
The epidemiology of inflammatory bowel disease in Asia and Asian immigrants to Western countries
Satimai Aniwan, Priscila Santiago, Edward V. Loftus, Sang Hyoung Park
United European Gastroenterology Journal.2022; 10(10): 1063. CrossRef
Public awareness toward inflammatory bowel disease in Saudi Arabia
Siraj Eid, Saeed Mohammad, Sulafa Noorelahi, Ali Asiri, Abdullah Taha, Ghallah Najee, Abdulkarim Aldukhail, Taif Alenezi, Rajis Aldosari
International Journal of Medicine in Developing Countries.2021; : 929. CrossRef
The Clinical Features of Inflammatory Bowel Disease in Patients with Obesity
Seong Kyun Kim, Ho-Su Lee, Beom-Jun Kim, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park, Masanao Nakamura
Canadian Journal of Gastroenterology and Hepatology.2021;[Epub] CrossRef
Optimal Cutoff Level of Fecal Calprotectin for Detecting Small Bowel Inflammation in Crohn's Disease
Eun Soo Kim
Gut and Liver.2021; 15(5): 637. CrossRef
Short-term tolerability and effectiveness of methotrexate monotherapy in adult patients with Crohn’s disease: a retrospective study
Hee Seung Hong, Kyuwon Kim, Kyunghwan Oh, Jae Yong Lee, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park
Therapeutic Advances in Gastroenterology.2021;[Epub] CrossRef
Epidemiology and diagnosis of inflammatory bowel diseases
Kang-Moon Lee
Journal of the Korean Medical Association.2021; 64(9): 579. CrossRef
Risk and characteristics of tuberculosis after anti-tumor necrosis factor therapy for inflammatory bowel disease: a hospital-based cohort study from Korea
Jae Yong Lee, Kyunghwan Oh, Hee Seung Hong, Kyuwon Kim, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Ho-Su Lee, Kyung-Wook Jo, Sang Hyoung Park
BMC Gastroenterology.2021;[Epub] CrossRef
Real world practice of medical treatment for moderate and severe inflammatory bowel diseases in Russian Federation, Republic of Belarus and Republic of Kazakhstan: intermediate results of the INTENT study
O. V. Knyazev, E. A. Belousova, D. I. Abdulganieva, I. V. Gubonina, J. A. Kaibullayeva, Yu. Kh. Marakhouski, E. Yu. Chashkova, M. V. Shapina, O. B. Shchukina, B. B. Gegenava, N. S. Oliferuk
Almanac of Clinical Medicine.2021; 49(7): 443. CrossRef
The first step to unveil the epidemiology of inflammatory bowel disease in Central Asia
Seung Wook Hong, Byong Duk Ye
Intestinal Research.2020; 18(4): 345. CrossRef
Pediatric Ulcerative Colitis in Kazakhstan: First Case Series from Central Asia and Current Clinical Management
Dimitri Poddighe, Aigerim Telman, Ernas Tuleutayev, Aigul Ibrayeva
Gastroenterology Insights.2020; 11(2): 27. CrossRef

PubReader
ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Prevalence and patient awareness of inflammatory bowel disease in Kazakhstan: a cross-sectional study

Intest Res. 2020;18(4):430-437. Published online September 29, 2020

DOI: https://doi.org/10.5217/ir.2019.00099

XML Download

Figure

Related articles

Prevalence and patient awareness of inflammatory bowel disease in Kazakhstan: a cross-sectional study

Fig. 1. Steps for inflammatory bowel disease (IBD) case identification.

Fig. 1.

Prevalence and patient awareness of inflammatory bowel disease in Kazakhstan: a cross-sectional study

Characteristics	Value (n = 115,556)
Age (yr)	44.2 ± 15.1
Age group (yr)
18–29	24,707 (21.4)
30–39	21,224 (18.4)
40–49	21,364 (18.5)
50–59	27,973 (24.2)
≥ 60	20,288 (17.6)
Sex
Male	41,708 (36.1)
Female	73,848 (63.9)
Area
Urban	92,908 (80.4)
Rural	22,648 (19.6)
Region
Almaty	37,444 (32.4)
East	25,332 (21.9)
West	11,108 (9.6)
North	29,107 (25.2)
South	12,565 (10.9)

Characteristics	IBD		UC		CD
Characteristics	Per 100,000	95% CI	Per 100,000	95% CI	Per 100,000	95% CI
Age group (yr)
18–29	129.5	83.3–175.7	89.0	50.2–127.9	40.5	13.0–67.9
30–39	155.5	100.9–210.1	117.8	69.8–165.7	37.7	8.5–66.9
40–49	117.0	69.4–164.7	74.9	36.0–113.8	42.1	11.7–72.5
50–59	75.1	41.5–108.7	53.6	24.7–82.5	21.4	1.6–41.3
≥ 60	83.8	41.7–125.9	69.0	30.4–107.6	14.8	0–36.4
Total	110.8	91.5–130.1	79.6	63.2–96.1	31.2	20.7–41.6
Sex
Male	129.5	94.3–164.6	107.9	75.7–140.1	21.6	6.0–37.2
Female	100.2	77.1–123.3	63.6	45.1–82.2	36.6	22.3–50.9
Area
Urban	114.1	92.2–136.0	81.8	63.2–100.4	32.3	20.4–44.2
Rural	97.1	54.8–139.5	70.6	33.9–107.3	26.5	2.0–51.0

Region	IBD		UC		CD
Region	Per 100,000	95% CI	Per 100,000	95% CI	Per 100,000	95% CI
Crude rates
Almaty	120.2	84.3–156.1	72.1	43.9–100.3	48.1	24.7–71.5
East	114.5	71.5–157.5	94.7	55.3–134.2	19.7	0–40.2
West	108.0	42.0–174.0	72.0	16.3–127.8	36.0	0–79.2
North	106.5	67.8–145.2	79.0	45.4–112.7	27.5	6.2–48.8
South	87.5	31.3–143.7	79.6	25.6–133.6	8.0	0–35.0
Total	110.8	91.5–130.1	79.6	63.2–96.1	31.2	20.7–41.6
Age/sex-adjusted rates
Almaty	121.1	41.0–201.3	72.4	9.4–135.5	48.7	0–98.2
East	126.5	15.4–237.6	108.2	3.6–212.9	18.3	0–55.5
West	102.4	0–235.3	72.5	0–190.7	29.9	0–90.5
North	109.4	20.7–198.1	84.9	4.6–165.3	24.5	0–62.0
South	87.7	0–176.2	81.1	0–164.8	6.6	0–35.5
Total	113.9	69.0–158.9	84.4	44.8–123.9	29.5	8.2–50.9

Localization	No. (%)
UC (n = 92)
Extent
E1 (proctitis)	30 (32.6)
E2 (left side colitis)	41 (44.6)
E3 (pancolitis)	21 (22.8)
Severity
S1 (mild UC)	21 (22.8)
S2 (moderate UC)	47 (51.1)
S3 (severe UC)	24 (26.1)
CD (n=36)
Location
L1 (ileal)	15 (41.7)
L2 (colonic)	7 (19.4)
L3 (ileocolonic)	14 (38.9)
Behavior
B1 (non-stricturing, non-penetrating)	20 (55.6)
B2 (structuring)	14 (38.9)
B3 (penetrating)	2 (5.6)
p (perianal disease modifier)	1 (2.8)

Characteristics	Unaware (n=25)	Aware (n=103)	P-value^a
Sex			0.121
Male	7 (28)	47 (45.6)
Female	18 (72)	56 (54.4)
Age (yr)			0.187
18–40 (A2)	16 (64)	50 (48.5)
> 40 (A3)	9 (36)	53 (51.5)
Area			0.943
Urban	19 (76)	75 (72.8)
Rural	6 (24)	28 (27.2)

Characteristics	Unaware (n=25)	Aware (n=103)	P-value
IBD type			0.332^a
UC	16 (64)	76 (73.8)
CD	9 (36)	27 (26.2)
Stool frequency, time/day			< 0.001
<5	23 (92)	49 (47.6)
6–10	2 (8)	37 (35.9)
> 10	0 (0)	17 (16.5)
Requires steroids treatment (yes)	9 (37.5)	42 (48.3)	0.367^a
History of GIT surgery due to IBD (yes)	2 (8)	12 (11.7)	0.867^b
Blood in stool (yes)	7 (28)	26 (25.2)	0.801^a
Abdominal pain (yes)	8 (32)	19 (18.4)	0.171^a
Subfebrile fever (yes)	10 (40)	33 (32.0)	0.487^a
Perianal disease (yes)	2 (8)	22 (21.4)	0.159^b
Aphthae (yes)	5 (20)	23 (22.3)	1.000^a
Abdominal infiltrate (yes)	3 (12)	8 (7.8)	0.448^b
Skin disorders (yes)	4 (16)	8 (7.8)	0.248^b
Musculoskeletal disorders (yes)	11 (44)	58 (56.3)	0.371^a
Hepatobiliary system disorders (yes)	2 (8)	33 (32.0)	0.022^b
BMI (kg/m²)			0.243^a
< 18.5	2 (8)	11 (10.7)
18.5–24.99	16 (64)	68 (66.0)
25–30	7 (28)	18 (17.5)
>30	0	6 (5.8)

Table 1. Demographic Characteristics of the Study Participants

Values are presented as mean±standard deviation or number (%).

Table 2. Prevalence of IBD and Its Types across Age, Sex and Geographical Location in Kazakhstan

IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease; CI, confidence interval.

Table 3. Prevalence of IBD and Its Types by Regions

IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease; CI, confidence interval.

Table 4. Clinical Characteristics of IBD-Based on the Montreal Classification

IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease.

Table 5. An Association between Inflammatory Bowel Disease Awareness Status and Demographic Characteristics

Values are presented as number (%).

Fisher exact test.

Table 6. An Association between IBD Awareness Status and Clinical Manifestations

Chi-square test.

Fisher exact test.

IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease; GIT, gastrointestinal tract; BMI, body mass index.