Background & Aims: Despite the rapid increase in inflammatory bowel disease (IBD), population-level familial risk estimates of IBDs still are lacking in Asian-Pacific countries. We aimed to quantify the familial risk of incident IBD among first-degree relatives (FDRs) of individuals with IBD according to age, sex, and familial relationship. Methods: Using the South Korea National Health Insurance database (2002–2017), which has complete population coverage and confirmed accuracy of both FDR information and IBD diagnoses, we constructed a cohort of 21,940,795 study subjects comprising 12 million distinct families. We calculated incidence risk ratios of ulcerative colitis (UC) or Crohn's disease (CD) in individuals of affected FDRs compared with individuals without affected FDRs. Results: Of 45,717 individuals with UC and 17,848 individuals with CD, 3.8% and 3.1% represented familial cases, respectively. Overall, there was a 10.2-fold (95% CI, 9.39–11.1) and a 22.1-fold (95% CI, 20.5–24.5) significantly higher adjusted risk of UC and CD among FDRs of individuals with vs without IBD. Familial risk was highest among twins, followed by nontwin siblings, and then offspring of affected parents. Familial risk generally was higher within generations (sibling–sibling) vs between generations (parent–offspring). Familial risk also increased with the increasing number of affected FDRs. Conclusions: According to this population-based analysis, there is a substantially increased risk of IBD among FDRs of affected individuals, with the highest risk among siblings and for CD. These findings might help with an earlier diagnosis and appropriate therapeutic intervention in FDRs of individuals with IBD. Dedicated studies are needed to evaluate the contributions of shared early-in-life environmental exposures and genetic factors.
Bibliographical noteFunding Information:
The current affiliation for Taeuk Kang is Health and Wellness College, Sungshin Women's University, Korea. Hyun Jung Kim, MPH, PhD (Conceptualization: Lead; Formal analysis: Lead; Investigation: Lead; Methodology: Lead; Resources: Lead);, Shailja C. Shah, MD, MPH (Conceptualization: Lead; Methodology: Lead; Writing – original draft: Lead; Writing – review & editing: Lead; Data interpretation: Lead);, Hoo Jae Hann, MD, PhD (Investigation: Lead; Project administration: Lead; Resources: Lead; Supervision: Lead; Validation: Lead; Critical review: Lead);, Sayada Zartasha Kazmi, MD (Investigation: Lead; Project administration: Lead; Visualization: Lead; Writing – original draft: Lead);, Taeuk Kang, MPH, PhD (Data curation: Lead; Formal analysis: Lead);, Jee Hyun Lee, MD (Formal analysis: Lead; Project administration: Equal);, Kyoung-Beom Kim, MPH (Project administration: Equal; Software: Lead);, Min Ji Kang, MPH (Project administration: Equal);, Hyeong Sik Ahn, MD, PhD (Conceptualization: Lead; Funding acquisition: Lead; Investigation: Lead; Methodology: Lead; Project administration: Lead; Supervision: Lead; Validation: Lead).
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