Techniques in Coloproctology

, Volume 23, Issue 8, pp 713–721 | Cite as

Diverticular disease epidemiology: acute hospitalisations are growing fastest in young men

  • J. B. BroadEmail author
  • Z. Wu
  • S. Xie
  • I. P. Bissett
  • M. J. Connolly
Original Article



Older age has long been linked to risk of diverticulitis, but the epidemiology is seldom described for a national population. The aim of this study was to investigate age- and gender differences in incidence, temporal trends, lifetime risk and prevalence related to acute diverticulitis hospitalisations in New Zealand.


Records of all hospitalisations with diverticulitis the primary diagnosis were obtained from the Ministry of Health for the period 2000–2015. The first acute diverticulitis admission recorded for an individual was taken as an incident event; all others were classified as recurrent. Trends in age- and sex-specific and age-standardised incidence rates are described, and lifetime risk and prevalence estimated.


Over the 16 years from 2000 to 2015, 37,234 acute hospitalisations for diverticulitis were recorded in 28,329 people aged 30 + years (median = 66 years). Rates of incident hospitalisations rose with age, from 5/10,000 person-years at age 50–54 years to 19/10,000py by age 80–84 years. Rates for women were lower than men before age 55 years, but higher thereafter. Age-standardised rates rose 0.2/10,000py annually, but approximately doubled among men aged < 50 years. Lifetime risk was estimated at over 5%, with the prevalence pool rising to over 1.5% of the population aged 30+ in 2030.


Rapid increases in diverticulitis admissions among young men since 2000 correspond with increases reported elsewhere but remain unexplained; notably young women follow similar trends 5–10 years later. Increasing incidence, combined with population ageing, adds urgency to explain diverticular formation, to understand factors that trigger or provoke their inflammation/infection, and to clarify treatment and (self-)management pathways.


Diverticulitis Diverticulum Colon Epidemiology Sex factors Age factors 



We gratefully acknowledge two University of Auckland Summer Studentships which supported this work, one funded by the HOPE Foundation, a charitable organisation supporting research into the health of older people in New Zealand. A University of Auckland internal research grant provided salary support for statistical analyses. Early discussions with Dr Steven Burmeister and Mr Matthew Soop were much appreciated.


This work was Funded by Faculty of Medical and Health Sciences, University of Auckland (Grant No. 3709593).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The University of Auckland Human Participants Ethics Committee gave ethical approval (Ref. 8944).

Informed consent

The Ethics Committee determined that no informed consent was required for this study.


  1. 1.
    Strate LL, Morris AM (2019) Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterol 156(5):1282–1298e1. (published Online First: 2019/01/21) CrossRefGoogle Scholar
  2. 2.
    Sim GP, Scobie BA (1982) Large bowel diseases in New Zealand based on 1118 air contrast enemas. N Z Med J 95(715):611–613 (published Online First: 1982/09/08) Google Scholar
  3. 3.
    Christie PM, Shaw JH (1988) Diverticular disease in Auckland. Aust N Z J Surg 58(10):795–799 (published Online First: 1988/10/01) CrossRefGoogle Scholar
  4. 4.
    Eglinton T, Nguyen T, Raniga S et al (2010) Patterns of recurrence in patients with acute diverticulitis. Br J Surg 97(6):952–957. (published Online First: 2010/05/18) CrossRefGoogle Scholar
  5. 5.
    Westwood DA, Eglinton TW, Frizelle FA (2011) Routine colonoscopy following acute uncomplicated diverticulitis. Br J Surg 98(11):1630–1634. (published Online First: 2011/06/30) CrossRefGoogle Scholar
  6. 6.
    Vather R, Broad JB, Jaung R et al (2015) Demographics and trends in the acute presentation of diverticular disease: a national study. ANZ J Surg 85(10):744–748. CrossRefGoogle Scholar
  7. 7.
    Ahmad O, Boschi-Pinto C, Lopez A et al (2001) Age standardization of rates: a new WHO standard. World Health Organization, GenevaGoogle Scholar
  8. 8.
    Lutwak N, Dill C (2012) CT scans in diagnosing diverticulitis in the Emergency Department: is the radiation exposure warranted? Dis Colon Rectum 55(2):226–227CrossRefGoogle Scholar
  9. 9.
    Camilleri M, Lee JS, Viramontes B et al (2000) Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people. J Am Geriatr Soc 48(9):1142–1150 (published Online First: 2000/09/13) CrossRefGoogle Scholar
  10. 10.
    Broad JB, Wu Z, Clark TG et al (2019) Diverticulosis and nine connective tissue disorders: epidemiological support for an association. Connect Tissue Res. Google Scholar
  11. 11.
    Longstreth GF, Iyer RL, Chu LH et al (2012) Acute diverticulitis: demographic, clinical and laboratory features associated with computed tomography findings in 741 patients. Aliment Pharmacol Ther 36(9):886–894. (published Online First: 2012/09/13) CrossRefGoogle Scholar
  12. 12.
    Cole CD, Wolfson AB (2007) Case series: diverticulitis in the young. J Emerg Med 33(4):363–366. (published Online First: 2007/11/03) CrossRefGoogle Scholar
  13. 13.
    Binda GA, Mataloni F, Bruzzone M et al (2018) Trends in hospital admission for acute diverticulitis in Italy from 2008 to 2015. Tech Coloproctol. (published Online First: 2018/09/10) Google Scholar
  14. 14.
    Cammarota S, Cargiolli M, Andreozzi P et al (2018) Increasing trend in admission rates and costs for acute diverticulitis during 2005–2015: real-life data from the Abruzzo Region. Therap Adv Gastroenterol 11:1756284818791502CrossRefGoogle Scholar
  15. 15.
    Kang JY, Hoare J, Tinto A et al (2003) Diverticular disease of the colon—on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 17(9):1189–1195. CrossRefGoogle Scholar
  16. 16.
    Talabani AJ, Lydersen S, Endreseth BH et al (2014) Major increase in admission- and incidence rates of acute colonic diverticulitis. Int J Colorectal Dis 29(8):937–945. CrossRefGoogle Scholar
  17. 17.
    Hupfeld L, Pommergaard HC, Burcharth J et al (2018) Emergency admissions for complicated colonic diverticulitis are increasing: a nationwide register-based cohort study. Int J Colorectal Dis. (published Online First: 2018/05/24) Google Scholar
  18. 18.
    Forero Torres AA. Características epidemiológicas de la enfermedad diverticular del colon y de la diverticulitis aguda en Castilla y León. Aspectos sobre el tratamiento médico y quirúrgico. [Epidemiological characteristics of diverticular disease of the colon and acute diverticulitis in Castilla y León. Aspects of medical and surgical treatment]. Universidad de Valladolid, 2016Google Scholar
  19. 19.
    Etzioni DA, Cannom RR, Ault GT et al (2009) Diverticulitis in California from 1995 to 2006: increased rates of treatment for younger patients. Am Surg 75(10):981–985Google Scholar
  20. 20.
    Lamm R, Mathews SN, Yang J et al (2017) 20-year trends in the management of diverticulitis across New York state: An analysis of 265,724 patients. J Gastrointest Surg 21(1):78–84. (published Online First: 2016/07/28) CrossRefGoogle Scholar
  21. 21.
    Bharucha AE, Parthasarathy G, Ditah I et al (2015) Temporal trends in the incidence and natural history of diverticulitis: a population-based study. Am J Gastroenterol 110(11):1589–1596. CrossRefGoogle Scholar
  22. 22.
    Masoomi H, Buchberg BS, Magno C et al (2011) Trends in diverticulitis management in the United States from 2002 to 2007. Arch Surg 146(4):400–406. (published Online First: 2010/12/22) CrossRefGoogle Scholar
  23. 23.
    Nguyen GC, Sam J, Anand N (2011) Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol 17(12):1600–1605CrossRefGoogle Scholar
  24. 24.
    Tandon A, Fretwell VL, Nunes QM et al (2018) Antibiotics versus no antibiotics in the treatment of acute uncomplicated diverticulitis—a systematic review and meta-analysis. Colorectal Dis. (published Online First: 2018/01/13) Google Scholar
  25. 25.
    Cirocchi R, Randolph JJ, Binda GA et al (2019) Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis. Tech Coloproctol 23(2):87–100. (published Online First: 2019/01/27) CrossRefGoogle Scholar
  26. 26.
    Jeyarajah S, Papagrigoriadis S (2008) Diverticular disease increases and effects younger ages: an epidemiological study of 10-year trends. Int J Colorectal Dis 23(6):619–627. (published Online First: 2008/02/16) CrossRefGoogle Scholar
  27. 27.
    Etzioni DA, Mack TM, Beart RW Jr et al (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249(2):210–217CrossRefGoogle Scholar
  28. 28.
    Weizman AV, Nguyen GC (2011) Diverticular disease: epidemiology and management. Can J Gastroenterol 25(7):385–389 (published Online First: 2011/08/310 CrossRefGoogle Scholar
  29. 29.
    Paterson HM, Arnott ID, Nicholls RJ et al (2015) Diverticular disease in Scotland: 2000-2010. Colorectal Dis 17(4):329–334. (published Online First: 2014/11/02) CrossRefGoogle Scholar
  30. 30.
    Eide TJ, Stalsberg H (1979) Diverticular-disease of the large-intestine in northern Norway. Gut 20(7):609–615. CrossRefGoogle Scholar
  31. 31.
    Manousos ON, Truelove SC, Lumsden K (1967) Prevalence of colonic diverticulosis in general population of Oxford area. Br Med J 3(5568):762–763 (published Online First: 1967/09/23) CrossRefGoogle Scholar
  32. 32.
    Reichert MC, Lammert F (2015) The genetic epidemiology of diverticulosis and diverticular disease: emerging evidence. United European Gastroenterol J 3(5):409–418. (published Online First: 2015/11/05) CrossRefGoogle Scholar
  33. 33.
    Granlund J, Svensson T, Olen O et al (2012) The genetic influence on diverticular disease—a twin study. Aliment Pharmacol Ther. (published Online First: 2012/03/22) Google Scholar
  34. 34.
    Strate LL, Erichsen R, Baron JA et al (2013) Heritability and familial aggregation of diverticular disease: a population-based study of twins and siblings. Gastroenterol 144(4):736–742. (published Online First: 2013/01/15) CrossRefGoogle Scholar
  35. 35.
    Sigurdsson S, Alexandersson KF, Sulem P et al (2017) Sequence variants in ARHGAP15, COLQ and FAM155A associate with diverticular disease and diverticulitis. Nat Commun 8:15789. CrossRefGoogle Scholar
  36. 36.
    Tursi A (2017) TNFSF15 polymorphism and diverticulitis of the colon: another step toward a more tailored approach in a complex disease. Ann Surg 265(4):e33. (published Online First: 2017/03/08) CrossRefGoogle Scholar
  37. 37.
    Hellwig I, Bottner M, Barrenschee M et al (2014) Alterations of the enteric smooth musculature in diverticular disease. J Gastroenterol 49(8):1241–1252. (published Online First: 2013/10/12) CrossRefGoogle Scholar
  38. 38.
    Wijarnpreecha K, Ahuja W, Chesdachai S et al (2018) Obesity and the risk of colonic diverticulosis: a meta-analysis. Dis Colon Rectum 61(4):476–483. (published Online First: 2018/03/10) CrossRefGoogle Scholar
  39. 39.
    Tirumanisetty P, Takahashi N, Lee TH et al (2017) Diverticulitis is associated with increased abdominal visceral and subcutaneous fat and muscle mass: a population-based study. Gastroenterol 152(5 Suppl 1):S736–S737CrossRefGoogle Scholar
  40. 40.
    Aune D, Sen A, Leitzmann MF et al (2017) Body mass index and physical activity and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies. Eur J Nutr 56(8):2423–2438. (published Online First: 2017/04/11) CrossRefGoogle Scholar
  41. 41.
    Hall JF (2014) The microbiome and diverticulitis: a new target for medical therapy? Dis Colon Rectum 57(4):544–545. CrossRefGoogle Scholar
  42. 42.
    Daniels L, Budding AE, de Korte N et al (2014) Fecal microbiome analysis as a diagnostic test for diverticulitis. Eur J Clin Microbiol Infect Dis 33(11):1927–1936. CrossRefGoogle Scholar
  43. 43.
    Maguire LH, Song M, Strate LE et al (2013) Higher serum levels of vitamin D are associated with a reduced risk of diverticulitis. Clin Gastroenterol Hepatol 11(12):1631–1635. CrossRefGoogle Scholar
  44. 44.
    Sikirov D (2003) Comparison of straining during defecation in three positions—results and implications for human health. Dig Dis Sci 48(7):1201–1205. CrossRefGoogle Scholar
  45. 45.
    Aune D, Sen A, Norat T et al (2019) Dietary fibre intake and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies. Eur J Nutr. (published Online First: 2019/05/01) Google Scholar
  46. 46.
    Feuerstein JD, Falchuk KR (2016) Diverticulosis and diverticulitis. Mayo Clin Proc 91(8):1094–1104. (published Online First: 2016/05/10) CrossRefGoogle Scholar
  47. 47.
    Lee TH, Setty PT, Parthasarathy G et al (2018) Aging, obesity, and the incidence of diverticulitis: a population-based study. Mayo Clin Proc 93(9):1256–1265CrossRefGoogle Scholar
  48. 48.
    Finucane MM, Stevens GA, Cowan MJ et al (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 91 million participants. Lancet 377(9765):557–567. (published Online First: 2011/02/08) CrossRefGoogle Scholar
  49. 49.
    Kopylov U, Ben-Horin S, Lahat A et al (2012) Obesity, metabolic syndrome and the risk of development of colonic diverticulosis. Digestion 86(3):201–205. (published Online First: 2012/08/22) CrossRefGoogle Scholar
  50. 50.
    Rodgers A, Woodward A, Swinburn B et al (2018) Prevalence trends tell us what did not precipitate the US obesity epidemic. Lancet Public Health 3(4):e162–e163. (published Online First: 2018/03/05) CrossRefGoogle Scholar
  51. 51.
    Ministry of Health (2013 ) New Zealand Health Survey: Annual update of key findings 2012/13. Wellington: Ministry of Health. Accessed 4 June 2019
  52. 52.
    Lee TH, Tirumanisetty P, Parthasarathy G et al (2017) Relationship between BMI and temporal trends in the incidence, complications, surgery, and survival after diverticulitis: a population-based study [Abstract]. Gastroenterol 152:S940CrossRefGoogle Scholar
  53. 53.
    Mahmood MW, Abraham-Nordling M, Hakansson N et al (2018) High intake of dietary fibre from fruit and vegetables reduces the risk of hospitalisation for diverticular disease. Eur J Nutr. Google Scholar
  54. 54.
    Wilson MM, Reedy J, Krebs-Smith SM (2016) American diet quality: where it is, where it is heading, and what it could be. J Acad Nutr Diet 116(2):302–310e1. (published Online First: 2015/11/28) CrossRefGoogle Scholar
  55. 55.
    Sikirov BA (1988) Etiology and pathogenesis of diverticulosis coli: a new approach. Med Hypotheses 26:17–20CrossRefGoogle Scholar
  56. 56.
    Daniels L, de Korte N, Winter D et al (2012) Overtreatment of sigmoid diverticulitis: plea for a less aggressive approach. Dig Dis 30(1):86–91. (published Online First: 2012/05/11) CrossRefGoogle Scholar
  57. 57.
    Shahedi K, Fuller G, Bolus R et al (2013) Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol 11(12):1609–1613. (published Online First: 2013/07/17) CrossRefGoogle Scholar
  58. 58.
    Mudhar HS, Balsitis M (2005) Colonic angiodysplasia and true diverticula: is there an association? Histopathology 46(1):81–88. CrossRefGoogle Scholar
  59. 59.
    Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States Part II: lower gastrointestinal diseases. Gastroenterol 136(3):741–754. (published Online First: 2009/01/27s) CrossRefGoogle Scholar
  60. 60.
    Shaheen NJ, Hansen RA, Morgan DR et al (2006) The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol 101(9):2128–2138. (published Online First: 2006/07/20) CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • J. B. Broad
    • 1
    Email author
  • Z. Wu
    • 1
  • S. Xie
    • 1
  • I. P. Bissett
    • 2
  • M. J. Connolly
    • 1
  1. 1.Department of Geriatric MedicineUniversity of AucklandAucklandNew Zealand
  2. 2.Department of SurgeryUniversity of Auckland and Auckland District Health BoardAucklandNew Zealand

Personalised recommendations