The Evolving Epidemiology of Diverticulitis: Global Trends and Disparities in Care

Abstract Diverticular disease is a common disease of the Western world; however, its epidemiology, presentation, and management have changed dramatically over the past century. Initially described in the 1700s, diverticular disease became an increasingly frequent finding, especially as imaging techniques were developed. The “fiber hypothesis” was proposed in the 1960's to explain the rising incidence of diverticular disease in westernized countries, suggesting it was secondary to reduced fiber in the diet. However, more recent studies suggest it is multifactorial, including genetics, lifestyle, and medications. Overall, the incidence of diverticular disease is increasing, and there is a rising trend of male patients below the age of 50 who are presenting with acute diverticulitis. Traditionally, diverticular disease has been right-sided in Eastern populations compared to the West, where it is commonly found in the sigmoid colon. More recently, though, there is a rising incidence of bilateral and left-sided disease in Eastern countries. Global disparities in the care and outcomes of diverticular disease are becoming more evident. More socio-economically deprived populations have higher rates of emergency admissions, complications, and reduced access to elective care. There are global differences in the rates of elective resections, the use of antibiotics, and the outpatient treatment of uncomplicated diverticulitis. This article will explore the implications of the topics outlined above. A better understanding of the changing epidemiology of diverticular disease and associated disparities in care is essential to developing more equitable, evidence-based management in diverse populations.