Prevalence of disability in inflammatory bowel disease: a systematic review and meta-analysis

BACKGROUND AND AIMS: Disability is a multidimensional concept that includes physical, psychological, and social limitations affecting individuals with inflammatory bowel disease (IBD). Disability is shaped by cultural and health care factors that vary across countries and therefore disability prevalence and characteristics may differ globally. We conducted a systematic review with meta-analysis to assess the pooled prevalence of moderate-to-severe disability and investigate how IBD type, disease activity, geographic location, and questionnaire used influenced prevalence. METHODS: We searched MEDLINE, Embase, and Embase Classic (from database inception to March 1, 2025) for cross-sectional, cohort, registry-based, and case-control studies reporting the prevalence of moderate-to-severe disability based on the IBD Disk or IBD-Disability Index in adults with confirmed IBD. RESULTS: In total, 17 articles fulfilled the eligibility criteria, including 7897 patients in 17 countries. The pooled prevalence of moderate-to-severe disability in patients with IBD was 29.6% (95% CI, 22.6%-37.1%) and was higher in patients with active IBD (56.9%; 95% CI, 20.3%-89.9%) compared with those with inactive disease (27.0%, 95% CI, 3.3%-62.0%). Based on 3 studies, disease activity increased the odds of moderate-to-severe disability more than 3-fold (odds ratio [OR], 3.13, 95% CI, 1.74-5.64). Stratified by IBD type, moderate-to-severe disability was higher in patients with Crohn disease (36.9%; 95% CI, 25.7%-48.9%) than in ulcerative colitis (30.8%; 95% CI, 19.6%-43.2%), with OR 1.26 (95% CI, 1.06-1.51). CONCLUSIONS: This systematic review is the first, to our knowledge, to show that moderate-to-severe disability affects nearly one-third of patients with IBD, with higher rates in Crohn disease and active disease. Importantly, disability persists in a substantial proportion of patients even during remission, supporting the need for systematic assessment across clinical settings.