Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Dec 20, 2023; 13(5): 475-483
Published online Dec 20, 2023. doi: 10.5662/wjm.v13.i5.475
Inflammatory bowel disease among first generation immigrants in Israel: A nationwide epi-Israeli Inflammatory Bowel Disease Research Nucleus study
Mira Stulman, Gili Focht, Yiska Loewenberg Weisband, Shira Greenfeld, Amir Ben Tov, Natan Ledderman, Eran Matz, Ora Paltiel, Shmuel Odes, Iris Dotan, Eric Ian Benchimol, Dan Turner
Mira Stulman, Gili Focht, Dan Turner, The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9103102, Israel
Mira Stulman, Ora Paltiel, Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9574869, Israel
Yiska Loewenberg Weisband, Clalit Research Institute, Tel Aviv 6209804, Israel
Shira Greenfeld, Amir Ben Tov, Maccabi Health Services and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6801296, Israel
Natan Ledderman, Meuhedet Health Services, Tel Aviv 6203854, Israel
Eran Matz, Leumit Health Services, Tel Aviv 6473704, Israel
Shmuel Odes, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
Iris Dotan, Department of Gastroenterology, Rabin Medical Center, Petah Tikva 49100, Israel
Eric Ian Benchimol, Department of Paediatrics and Institute of Health Policy, Management and Evaluation, The Hospital for Sick Children, University of Toronto, Toronto M5G 1X8, ON, Canada
Eric Ian Benchimol, SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Child Health Evaluative Sciences, The Hospital for Sick Children and the SickKids Research Institute, Toronto M5G 1X8, Canada
Eric Ian Benchimol, ICES, Toronto M4N 3M5, Canada
Author contributions: Stulman M designed and conceptualized the study, collected, analyzed, and interpreted the data, and drafted the manuscript; Focht G, Loewenberg Weisband Y, Greenfeld S, Ben Tov A, Ledderman N, and Matz E contributed to data acquisition; Paltiel O, Odes S, Dotan I, and Benchimol EI contributed in data analysis and interpretation; Turner D designed and conceptualized the study, contributed to data analysis and interpretation, and drafted the manuscript.
Supported by the Leona M. and Harry B. Helmsley Charitable Trust, No. G-2018PG-CD009.
Institutional review board statement: The Institutional Review Board of Shaare Zedek Medical Center approved the study (Approval No. SZMC-0134-17).
Informed consent statement: The Shaare Zedek Medical Center IRB has waived the requirement to obtain informed consent.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dan Turner, MD, PhD, The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Shmuel (Hans) Beyth St 12, Jerusalem 9103102, Israel. turnerd@szmc.org.il
Received: September 13, 2023
Peer-review started: September 13, 2023
First decision: October 7, 2023
Revised: October 17, 2023
Accepted: November 3, 2023
Article in press: November 3, 2023
Published online: December 20, 2023

Israel has a high rate of Jewish immigration and a high prevalence of inflammatory bowel disease (IBD).


To compare IBD prevalence in first-generation immigrants vs Israel-born Jews.


Patients with a diagnosis of IBD as of June 2020 were included from the validated epi-IIRN (Israeli IBD Research Nucleus) cohort that includes 98% of the Israeli population. We stratified the immigration cohort by IBD risk according to country of origin, time period of immigration, and age group as of June 2020.


A total of 33544 patients were ascertained, of whom 18524 (55%) had Crohn’s disease (CD) and 15020 (45%) had ulcerative colitis (UC); 28394 (85%) were Israel-born and 5150 (15%) were immigrants. UC was more prevalent in immigrants (2717; 53%) than in non-immigrants (12303, 43%, P < 0.001), especially in the < 1990 immigration period. After adjusting for age, longer duration in Israel was associated with a higher point prevalence rate in June 2020 (high-risk origin: Immigration < 1990: 645.9/100000, ≥ 1990: 613.2/100000, P = 0.043; intermediate/low-risk origin: < 1990: 540.5/100000, ≥ 1990: 192.0/100000, P < 0.001). The prevalence was higher in patients immigrating from countries with high risk for IBD (561.4/100000) than those originating from intermediate-/low-risk countries (514.3/100000; P < 0.001); non-immigrant prevalence was 528.9/100000.


Lending support to the environmental effect on IBD etiology, we found that among immigrants to Israel, the prevalence of IBD increased with longer time since immigration, and was related to the risk of IBD in the country of origin. The UC rate was higher than that of CD only in those immigrating in earlier time periods.

Keywords: Epidemiology, Inflammatory bowel disease, Immigration, Environment

Core Tip: In this nationwide study, we compared inflammatory bowel disease (IBD) rates between first-generation immigrants originating from countries of varying IBD risk vs Israel-born residents. Our focus on the Jewish population was aimed at narrowing the genetic variation of IBD that is usually present in immigration cohorts. We found that the prevalence rate was lower among patients from intermediate- and low-risk regions compared to patients from high-risk regions but in both, the prevalence increased in association with duration in Israel after immigration. This finding, especially among immigrants from intermediate- and low-risk countries, lends support toward the role of environmental factors in IBD pathogenesis in Israel.