Abstract Background Urbanisation has been associated with IBD, but the transition in most regions is too gradual. In rapidly industrialising settings like India, this transition is compressed into a single decade, creating an opportunity to quantify how fast environmental change affects disease risk. Traditional methods to assess urbanization struggle due to cost and lack of longitudinal granularity. We conducted a large rural IBD prevalence study in Telangana state in Southern India, pairing clinical field data with a satellite-derived deep learning urbanicity index1,2 to examine how 10 years of rapid urban development relates to IBD burden. Methods The rural outreach program covered 5 districts of Telangana. A door-to-door survey captured demographics, environmental factors, and key gastrointestinal symptoms (weight loss, diarrhoea, abdominal pain 0–1 scale where 1 depicts maximum urbanization;Fig1), validated against the population-density-based degree of urbanization DEGURBA index3. IBD prevalence was correlated with both current DLUI (2023) and the percentage rise in DLUI across 10y (2013–2023). Results 120122 individuals from 163 villages with a total population of 163990 were included. We identified 62 individuals with IBD (overall prevalence 5.1 per 100000). The median rose from 0.4 in 2013 (6.7% of villages index = 1) to 0.8 in 2023 (25.7% of villages index = 1). The median 2023 DLUI showed strong concordance with the DEGURBA index, with higher values in densely populated areas (R2 = 0.8). Villages with highest DLUI showed significantly high IBD prevalence of 18/100000 as compared to 4 in villages with lowest DLUI (Fig2A; p = 0.01). 140 of 163 villages showed an increase in DLUI. The rise in urbanization percentage from 2013-23 positively correlated with IBD prevalence. Villages with an 80–100% increase exhibited a 2.5-fold higher IBD prevalence compared to those with 20% change, demonstrating a graded rise across urbanicity quintiles (R2 = 0.92)(Fig2B). Conclusion Rapid urbanisation in rural India was strongly associated with higher village-level IBD prevalence, with a 2.5-fold gradient between villages with the greatest versus minimal 10-year increase in urbanicity. A deep learning–based satellite Urbanicity Index, validated against DEGURBA, provides a low-cost alternative to repeated longitudinal surveys in resource-limited settings References: 1. Banerjee R, Pal P, Patel R, et al. Inflammatory bowel disease (IBD) in rural and urban India: results from community colonoscopic evaluation of more than 30,000 symptomatic patients. The Lancet Regional Health - Southeast Asia. 2023;19:100259. doi:https://doi.org/10.1016/j.lansea.2023.100259; 2. Chakradeo K, Katsiferis A, Scheidwasser N, I, et al.Estimating the worst-case scenario for malaria parasite rate in sub-Saharan Africa Rxiv 2025.05.16.25327745; doi: https://doi.org/10.1101/2025.05.16.25327745; 3. Eurostat. Europa.eu. Published 2021. https://ec.europa.eu/eurostat/en/web/products-manuals-and-guidelines/-/ks-02-20-499 *A.S and K.C contributed equally Conflict of interest: Dr. Banerjee, Rupa: RB has received grants/research support from Asian Healthcare Foundation, and the Leona M and Harry B Helmsley Charitable Trust Advisory board fees from Abbott, AstraZeneca, Abbvie, Cadila, Cipla, Dr Reddy Labs, Eli Lilly, Emcure, Ferring Pharma, Hetero Drugs, Janssen, MSN Labs, Mankind Pharma, Menarini, Micro Labs, Pfizer, Sun Pharmaceuticals, Takeda Pharmaceuticals, Torrent, Waterley, and Zydus. Raghunathan, Nalini: No conflict of interest Mellacheruvu, Vineeth: No conflict of interest Pantham, Pravalika: No conflict of interest Reddy, Sudheer: No conflict of interest Sriramoj, Saikumar: No conflict of interest Reddy, Harshini: No conflict of interest Pal, Partha: Partha Pal received consultancy fees/speaker honorarium from Johnson and Johnson, Takeda Pharmaceutical Company, Cipla Ltd, Sun Pharma, Zydus Biosciences, Dr Reddy Labs, Abbott India, RPG Life sciences, La Renon Healthcare Pvt Ltd and Daewoong Pharma Patel, Rajendra: No conflict of interest Mekala, Dhanush: No conflict of interest Fracchia, Alice: No conflict of interest Jess, Tine: Personal Fees: Consultancy for Ferring, Pfizer, Johnson&Johnson Bhatt, Samir: No conflict of interest Chakradeo, Kaustubh: No conflict of interest Sazonovs, Aleksejs: No conflict of interest
Banerjee et al. (2026) studied this question.