Low rate of inflammatory bowel disease in the <scp>A</scp>ustralian indigenous paediatric population

Although inflammatory bowel disease (IBD) is more prevalent in the developed world than the developing world, recent studies demonstrate increasing rates in many Asian countries.1 Furthermore, several reports document increased incidence of IBD in populations migrating from the developing world to developed countries.2 In contrast, lower rates of IBD are observed in indigenous populations in New Zealand and Canada than in other individuals in these countries.3 Similarly, it is believed that the prevalence of IBD amongst the Aboriginal and Torres Strait Islander (ATSI) population in Australia is low, although no published data are available. We aimed to establish the rate of IBD in children of ATSI descent utilising the Australian Paediatric and Adolescent IBD Database, which contains clinical and demographic information on children and adolescents submitted by a physician at the time of diagnosis of IBD. General population data (based upon the 2006 Australian Census) were obtained from the Australian Bureau of Statistics (accessed online August 2011). Of the 2300 entries in the APAID, 13 children diagnosed with IBD (0.56%; 7 Crohn's disease, 3 ulcerative colitis, 3 unclassified IBD) were of ATSI descent (10 with one ATSI parent, 3 with two ATSI parents) (Table 1). In 2006, 4.13% of the paediatric population (0–19 years) was Indigenous, indicating a rate of paediatric IBD in the Indigenous population approximately eight times lower than in the non-Indigenous Australian population. One potential explanation for the low rates of IBD reported in the ATSI population is that children of ATSI descent may live in remote locations with less exposure to ‘clean/hygienic’ settings or less access to medical care for diagnosis of IBD. However, the census data indicate that the ATSI population has moved into urban and rural locations to a similar extent to the non-Indigenous population (Table 1). Furthermore, people of Indigenous descent have adopted diet and life-style patterns that have resulted in as high, if not higher, incidences of ‘developed-country diseases’ such as type I diabetes mellitus and heart disease as are found among non-Indigenous people.4 Therefore, the Australian Indigenous population appears to contradict the trend of increase in IBD rates with movement of populations to more ‘developed’ environs. These data suggest that Indigenous Australians may have an unidentified resilience to developing IBD; it is unclear if genetic or environmental factors are implicated. This first report of the low incidence of IBD among Indigenous Australians suggests that further investigation is urgently required.

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