Pattern and distribution of colorectal diverticulosis: A cross-sectional study in Southern China

Pattern and distribution of colorectal diverticulosis: A cross-sectional study in Southern China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pattern and distribution of colorectal diverticulosis: A cross-sectional study in Southern China Zhijie He, Jian Li, Yin Zhu, Xiaqin Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9533147/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 17 You are reading this latest preprint version Abstract Background Colorectal diverticulosis (CD) is easy to ignore in China for its low morbidity compared to western countries. However, the incidence of CD is rising in China, which might relate to the aging population and gradual westernization of lifestyle. Our study aims to determine the incidence, location, and sex differences associated with CD. Methods Patients who underwent colonoscopy at Nanchang University's first affiliation hospital between January 1, 2021, and December 31, 2023 were analyzed. All CD encountered during the procedure was evaluated and documented. The distribution of CD was classified as left-sided and/or right-sided. The associations between CD and participant characteristics were analyzed using logistic regression. Results A total of 56308 eligible patients from our endoscopy database were included. 2954 individuals (5.25%) were identified with CD. Patients with CD had a mean age of 53.2 years old and were notably older, with a higher proportion of males compared to those without CD. Females were significantly more susceptible than males of the same age to have CD after the age of 70 (OR 1.35, 95% CI 1.02–1.79). The number of patients with right-sided and left-sided CD ranged from 2772 (4.92%) to 318 (0.56%). Conclusion In Southern China, CD most frequently affects the right side and is more common in old males. Women over 70 years of age are more prone to developing CD. Patients with left-sided CD generally tend to be older than those with right-sided CD. colorectal diverticulosis colonoscopy distribution age gender Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Diverticulosis is a condition that occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon. The etiology and pathogenesis of colorectal diverticulum are not completely clear. Risk factors, such as age, gender, diet, physical activity, genetic factors, colorectal immobility, weakening of the colorectal wall, low-grade inflammation, and imbalances in microflora, play crucial roles in the development of diverticulum [ 1 – 4 ]. Its symptoms are often atypical, easy to misdiagnosis, and can also lead to local inflammation, abscess formation, intestinal obstruction, bleeding, perforation, internal fistula, and other related complications, seriously endangering the health of patients [ 1 ]. Diverticular diseases and their complications pose a substantial burden on worldwide healthcare systems. It is the eleventh most common outpatient diagnosis in the United States, with 207,150 as the principal diagnosis from hospital admissions at a cost of $ 9.0 billion in 2018 [ 5 ]. Worldwide, the prevalence of CD is rising. In industrialized nations like the United States and the United Kingdom, rates may fluctuate from 42% to 51.6% [ 6 – 8 ]. There has been a consistent increase in the incidence of CD in several Asian countries as they age and increasingly embrace a more westernized lifestyle. For instance, Nagata et al [ 9 ] observed that the proportion of CD increased from 18% in 2003 to 23% in 2011. The incidence of CD in China is significantly lower than in occidental nations. However, as China's social economy developed, the country's aging population became more problematic, medical standards improved, and growing affluence and globalization caused traditional lifestyles to shift toward a more westernized way of living. Recently, a colonoscopy-based survey from Northern China demonstrated 3.8% prevalence of CD, with a yearly increase in trends [ 10 ]. Yet, literature regarding the prevalence of CD in mainland China is sparse, obsolete, and localized. Besides, there are huge differences between Northern and Southern China. Therefore, we conducted a retrospective of one single center observation study of patients undergoing colonoscopy in our endoscopy center within the last 3 years. The aim of this research is to describe the characteristics and distribution of CD in Southern China while increasing Chinese clinicians' awareness of CD. Methods Subjects This cross-sectional study examined colonoscopy results from Nanchang University's first affiliated hospital in retrospect. The research was carried over the period January 1, 2021, to December 31, 2023. There were established age groups: ≤40, 41–50, 51–60, 61–70, > 70 years. Patients under 18 years old, foreign nationals, those with failed adequate bowel preparation or complete colonoscopy, repeat colonoscopy during the study period, and patients with colectomy or inflammatory bowel disease were excluded. Study design Each colonoscopy was conducted by at least two well-trained endoscopists in our endoscopy center. The results of colonoscopies were methodically examined and manually entered into a computer system for further examination. Before the exam, the bowel was prepared with a 3 L solution that contained polyethylene glycol electrolyte powder. The anatomical locations of CD were documented into the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Diverticula were classified into two locations: right-side (which included any diverticula reported in the cecum, ascending, and transverse colon), and left-side (which included any diverticula reported in the descending sigmoid and rectum colon). Statistical analysis Percentages were computed for categorical data. Age groups were created (≤ 40, 41–50, 51–60, 61–70, > 70 years). To estimate odds ratios and 95% confidence intervals while adjusting for potential confounders (age, sex, and location), a binomial multivariate logistic regression analysis was performed. The odds of CD by sex within each age group were modeled. In all two-tailed tests of significance, p-values less than 0.05 were considered statistically significant. The analysis was conducted using SPSS version 27.0 for Windows (SPSS Inc.). Results During the study period, a total of 56308 patients (25686 male and 30622 female) were included. 2954 (5.25%) had CD, 1716 male and 1238 female. We also assessed the location, and complication. However, only 1 case combined with bleeding and 2 cases combined with inflammation; 53 cases combined with intra-diverticular fecal impaction; and no intestinal perforation were observed in this study (Fig. 1 ). Patients with CD have a mean age of 53.2 and are statistically older than those without CD (Table 1 ). According to our data, the prevalence of CD increased with age. Patients over 70 exhibited a prominent increase of CD in comparison to those under 40. (OR 3.41, 95% CI 2.89–4.03). Interestingly, the majority of diverticulosis was located in the cecum and ascending colon with 53.6%, 50.6%. Only 8.2% were in the transverse colon, 6.1% in the descending colon, 7.1% were in the sigmoid colon, and 2.8% were in the rectum (Fig. 2 ). Table 1 Baseline Characteristic of Patients Age(y), Mean (SD) Total CD without CD OR † (95% CI) P-value † 48.2(13.3) 53.2(12.4) 47.9(13.3) ≤ 40 16037(28.5%) 468(15.8%) 15569(29.2%) 1.0(Reference) - 41–50 14832(26.3%) 695(23.5%) 14137(26.5%) 1.74(1.54,1.96) <0.001 51–60 15725(27.9%) 992(33.6%) 14733(27.6%) 2.43(2.17,2.72) <0.001 61–70 7255(12.8%) 579(19.6%) 6676(12.5%) 3.11(2.74,3.52) 70 2459(4.4%) 220(7.4%) 2239(4.2%) 3.41(2.89,4.03) <0.001 Sex Female 30622(54.4%) 1238(41.9%) 23970(44.9%) 1.0(Reference) - Male 25686(45.6%) 1716(58.1%) 29384(55.1%) 1.83(1.69,1.97) <0.001 Total 56308 2954 53354 † Comparison between those without CD and those with CD. CD, colorectal diverticulosis; OR, odds ratio; CI, confidence interval. CD was observed with a prevalence of 6.68% (1716/25686) in males, compared to 4.04% (1238/30622) in females. There was a notably male predominance in CD (Table 1 ). However, when stratified by age, the prevalence of CD in both male and female was increased with age under 70 years old. The prevalence of CD in males was slightly decreased with age over 70 years old, while females were opposite (Fig. 3 ). Females were significantly more susceptible than males to develop CD after the age of 70 (OR 1.35, 95% CI 1.02–1.79) (Table 2 ). Table 2 Prevalence and Adjusted Odds of CD by Sex Within Age Groups Age, years Sex Prevalence of CD OR † (95% CI) P † ≤ 40 Male 3.93% 1.0(Reference) - Female 1.75% 0.44(0.36,0.53) < 0.001 41–50 Male 6.90% 1.0(Reference) - Female 2.96% 0.41(0.35,0.48) < 0.001 51–60 Male 8.79% 1.0(Reference) - Female 4.62% 0.50(0.44,0.57) < 0.001 61–70 Male 9.21% 1.0(Reference) - Female 7.09% 0.75(0.63,0.89) 70 Male 7.67% 1.0(Reference) - Female 10.09% 1.35(1.02,1.79) < 0.001 † Comparison between those males with CD and females with CD in the same age group. CD, colorectal diverticulosis; OR, odds ratio; CI, confidence interval. We further assessed the location of CD. Regarding contrast with left-sided CD (318 cases; 0.56%), we found a greater prevalence of right-sided CD (2772 cases; 4.92%) in our study. Interestingly, those with right-sided CD often had a lower age of 8.64 years compared to those with left-sided CD (Table 3 ). Table 3 Prevalence and OR of CD Location by Sex, Age Group left-side 0.56% OR † (95% CI) P † right-side 4.92% OR ‡ (95% CI) P-value ‡ Sex Women 0.45% 1.0(Reference) - 3.76% 1.0(Reference) - Men 0.70% 1.74(1.39,2.18) < 0.001 6.31% 1.85(1.71,2.00) < 0.001 Age Group ≤ 40 0.06% 1.0(Reference) - 2.87% 1.0(Reference) - 41–50 0.23% 3.89(1.92,7.87) < 0.001 4.53% 1.70(1.51,1.92) < 0.001 51–60 0.71% 12.37(6.47,23.65) < 0.001 5.89% 2.30(2.05,2.58) < 0.001 61–70 1.41% 24.38(12.72,46.73) < 0.001 7.28% 2.86(2.51,3.25) 70 2.44% 41.58(21.25,81.34) < 0.001 7.52% 2.87(2.40,3.42) < 0.001 Age(y) Mean (SD) 61.4(10.6) 52.8(12.3) † Comparison between those without diverticulosis and those with left-colonic diverticulosis. ‡ Comparison between those without diverticulosis and those with right-colonic diverticulosis. CD, colorectal diverticulosis; OR, odds ratio; CI, confidence interval. In the multivariate logistic regression analyses, it was determined that patients aged in 41–50, 51–60, and 60–70 years with right-sided CD had a significantly higher likelihood (OR: 1.70, 2.30, and 2.86) of being aged ≤ 40 years. However, the prevalence of right-side CD did not consistently increase with age over 70 years old. (Table 3 ). When separated by sex, the prevalence of right-sided CD declined in male patients aged over 70 years, which resulted in the decline of the prevalence of CD in males as above mentioned. Conversely, patients with left-sided CD regardless of gender were found to have a continuous increase with all age groups (Fig. 4 ). Discussion In retrospectively analyzing the characteristics of colonoscopy patients at our institution, we found that the prevalence of CD in Southern China was 5.25%. However, colonoscopy can miss half of CD compared with barium enema [ 11 ]. Besides, the ignorance of CD in Chinese physicians further contributes to the potential underestimation of the prevalence of CD in our study. Concerning the prevalence of CD in China, Pan et al [ 12 ] first observed that the incidence of CD, as judged from the necropsy cases and colonoscopy cases, was 0.12% and 0.33%-1.2% from 1921–1985; Yang et al [ 13 ] demonstrated that the incidence of CD has risen from 2.78% in 2011 to 4.98% in 2015. Yan et al [ 2 ] determine that the incidence of CD was 7.3% in Eastern China in 2020. Our result of 5.25% of the incidence of CD appears to be rational because our data show that the prevalence of CD increased from 5.94% to 8.41 in 2021 to 2023. The complication of CD in this group was only 1.86% (55/2954) cases, which is much lower than that reported in the literature [ 14 , 15 ]. This may be related to the fact that patients with acute diverticulitis in this institute are not recommended to have colonoscopies due to potential risks associated with the surgery, particularly the higher risk of local or distant perforation, though this policy was lack of evidence [ 16 , 17 ]. It is recommended 4–6 weeks following an episode of acute diverticulitis to confirm CD and exclude out colorectal cancer [ 16 , 18 ]. However, some evidence demonstrated that the risk of malignancy after a CT-proven uncomplicated diverticulitis is low [ 19 ]. CD is associated with increasing age. According to Peery et al [ 20 ] the incidence increased from 57.43% in individuals over 60. Patients with CD (mean age: 53.24) in this study were considerably older than those without it (mean age: 47.89, P < 0.001). The extended duration of connective tissue exposure to intestinal contents may be the cause of this condition, since it increases susceptibility to different pathogenetic variables that may lead to diverticulosis [ 21 ]. China's growing aging population is currently posing issues. By 2050, the number of elderly people in China is predicted to surpass 400 million, making up 30% of the country's total population [ 22 ]. In part, the new study's findings support the notion that CD rates may continue to rise for many years in China. Males were more likely to develop CD in any location compared with females in this study. As we stratified patients by age and colonoscopy site, the right-side CD in males decreased in individuals aged over 70 years old (Fig. 4 ). As we all know, CD cannot be self-cured, but we believe it might contribute to the development of the economy since the economy reform in 1978. The adaptation to western lifestyle and diet accelerates the form of CD. Moreover, our data reveal that the elder female was more susceptible to CD. The OR value gets the bottle line at the age of 41–50 and rebounded with the age increase, which is just about menopausal age (Table 2 ). According to Peery's research, CD was less prevalent in females compared with males before the usual menopausal age [ 23 ]. This trend declined as women aged, suggesting that sex hormones may have an impact on etiology. According to our data, endogenous ovarian steroid hormones may lower the chance of CD. Prior studies have consistently demonstrated that, in contrast to the higher incidence of right-sided CD seen in Asian countries, left-sided CD is more prone in western countries [ 24 , 25 ]. In the United States, 72% of CD were in the sigmoid colon, 1 ~ 11% were in the cecum, and ascending colon in the United States [ 6 ]. However, 32.1% of CD were in the sigmoid colon, 29.6%~62.7% were in the cecum and ascending colon in Thailand [ 26 ]. Our research shows that 7.1% of CD was in sigmoid, 53.6%, and 50.6% were in the cecum and ascending. Additionally, Nakaji [ 27 ] et al. also find that Japanese-Americans living in Hawaii with Western diets and lifestyles still maintain a predominance of right-sided CD. This observation presents credence to the theory that CD is influenced by genetics in addition to diet and lifestyle. Interestingly, the location of the CD was linked to age, according to our research. Figure 4 shows that patients under 60 years old are more likely to develop right-sided CD (P < 0.001). While left-sided CD were seldom observed in patients under 60, they were frequently developed in those over 60 (P < 0.001). Additional research has also supported the found connection. For example, W. Hong et al. found that right-sided CD do not increase in incidence in those over 60, while left-sided CD are more prevalent into the eighth decade. Certain individuals propose that CD on the right side could be innate, while those on the left side could develop as a result of elevated intestinal pressure brought on by a low-fiber diet, luminal blockage, and contraction [ 28 ]. Furthermore, in line with our findings, Jensen's study proposed that CD advances with aging from the right-side colon to the left-sided colon. According to N. Isohata et al. [ 29 ] patients first experience diverticula on the right side of the colon, which eventually spread to the left as they age. There are limitations on our work. First of all, considering it's a single center with cross-sectional and retrospective analysis. The results of the present study require confirmation by a prospective study. Second, the participants in our study were from the southern Chinese city of Nanchang. Since dietary habits and lifestyles might range greatly throughout Chinese regions, our results might not be indicative of China as a whole [ 30 ]. Additionally, the mechanism behind the location and characteristic of CD was not examined in this study. Comprehensive research will be conducted in the future. Conclusion Our research based on the 56308 colonoscopy patients for 3 years indicated that the prevalence of CD is 5.25% in China. CD is primarily found on the right side in China, is more common in males, and is correlated with age. Notably, CD was more common in females over 70 years. Patients with left-sided CD are typically older than left-sided. Declarations Data availability statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Funding statement: No funding Declaration of conflict of interest: All authors declare that there is no conflict of interest or financial support relevant to this study. Ethics approval and informed consent: All participants were collected from the First Affiliated Hospital of Nanchang University. This study was approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University (IIT2025003) and was performed in accordance with the Declaration of Helsinki. This study was registered at Chinese Clinical Trial Registry (Chictr.org.cn, ChiCTR2500097648, 2025/02/24), All participants gave written informed consent as evidenced by the participants’ signature. Authors’ contributions: ZJH and XQC contributed equally to this work including designed the research, analyzed the date, wrote the paper; YZ performed the research; JL, XDZ and BW revised the paper. All authors read and approved the final manuscript. Acknowledgements: The authors appreciate the colleagues in the Nanchang University and Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University Hospital. We also appreciate the participants of subjects. References Tursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, et al. 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Supplementary Files PatternanddistributionofcolonicdiverticulaAcrosssectionalstudyinSouthernChina.xlsx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 20 May, 2026 Reviews received at journal 16 May, 2026 Reviews received at journal 09 May, 2026 Reviews received at journal 09 May, 2026 Reviewers agreed at journal 09 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviews received at journal 07 May, 2026 Reviews received at journal 06 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers agreed at journal 06 May, 2026 Reviewers invited by journal 06 May, 2026 Editor invited by journal 05 May, 2026 Editor assigned by journal 04 May, 2026 Submission checks completed at journal 04 May, 2026 First submitted to journal 26 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9533147","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":637500159,"identity":"e147d86c-d3fd-47e5-915a-fb8fca11c8f4","order_by":0,"name":"Zhijie He","email":"","orcid":"","institution":"Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Zhijie","middleName":"","lastName":"He","suffix":""},{"id":637500160,"identity":"8aaf036b-b22b-4b76-ba6f-0d4f3d9f8af0","order_by":1,"name":"Jian Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYFCCBIYPDAZsPPz8zQcgAgcIa2GcwVDBJyM541gCKVrOyNkYNOQYEKfFnD3HsJm3zYzHgOHMtwc/2xjk+G4kMH4uwKPFsucNSEsajzlz73bD3jYGY8kbCczSM/BoMbiRY/6Yt+0Yj2XD2W3SjG0MiRtuJLAx8+DXArLlP4/BgZxnIC31xGnhOcMG0sIG0pJgQFDLmWeFjXMq2HiAgWwm2XNOwnDmmYfN0ni1HE/e2PDGgM0eGJXPJH6U2cjzHU8++BmfFgYGDgMmJAUSQMzYgFcDAwP7A8YfBJSMglEwCkbBCAcA7F9OaeYT14AAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital, Jiangxi Medical College, Nanchang University,","correspondingAuthor":true,"prefix":"","firstName":"Jian","middleName":"","lastName":"Li","suffix":""},{"id":637500161,"identity":"a4ddd757-c719-4ff3-8538-5810c6d72a76","order_by":2,"name":"Yin Zhu","email":"","orcid":"","institution":"Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Yin","middleName":"","lastName":"Zhu","suffix":""},{"id":637500162,"identity":"57f5e8f7-f678-4659-9e5a-8f8a8a9e1fe8","order_by":3,"name":"Xiaqin Chen","email":"","orcid":"","institution":"Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Xiaqin","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2026-04-26 15:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9533147/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9533147/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109434844,"identity":"a7b6ca79-3d03-4251-9c67-be268e952345","added_by":"auto","created_at":"2026-05-18 05:55:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":636082,"visible":true,"origin":"","legend":"\u003cp\u003eA | colorectal diverticula. B | colorectal diverticula combined with bleeding. C | colorectal diverticula combined with intra-diverticular fecal impaction. D| colorectal diverticula combined with inflammation.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9533147/v1/07c7f592665b627e6d0e8955.jpg"},{"id":109434636,"identity":"f87acfb1-4d29-48ab-94be-e9adad17df9f","added_by":"auto","created_at":"2026-05-18 05:55:06","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":180880,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of colorectal diverticulosis stratified by colorectal segment (total number of CD=2954cases).\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9533147/v1/4005fc1ee8fc99f39378900b.jpg"},{"id":109434627,"identity":"e826942e-156b-4c70-8e21-ed85e155a50d","added_by":"auto","created_at":"2026-05-18 05:55:05","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":962664,"visible":true,"origin":"","legend":"\u003cp\u003eDiverticulosis on colonoscopy in by age and sex. Female are in orange bars and male in navy blue.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9533147/v1/1b05309de91ab13b0f952e66.jpg"},{"id":109434665,"identity":"72d0c1b4-0469-4d96-8c97-a4ae130187d1","added_by":"auto","created_at":"2026-05-18 05:55:14","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1698576,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Any Left and Right Diverticula by Sex Within Age Groups.\u003c/p\u003e\n\u003cp\u003eLCD, Left-sided colorectal diverticulosis; RCD, right-sided colorectal diverticulosis;\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9533147/v1/ccea9592d31b6c3cb03f11b0.jpg"},{"id":109434924,"identity":"2e18405d-9fc5-4178-8822-76cb884b1f62","added_by":"auto","created_at":"2026-05-18 05:55:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3711921,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9533147/v1/11d31fe6-d3aa-4268-bb74-7a7993059092.pdf"},{"id":109434624,"identity":"a0d34739-4cd9-4c13-b563-2ff90c9d100d","added_by":"auto","created_at":"2026-05-18 05:55:05","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":5787728,"visible":true,"origin":"","legend":"","description":"","filename":"PatternanddistributionofcolonicdiverticulaAcrosssectionalstudyinSouthernChina.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9533147/v1/f6f1b51b4ff1384fac457121.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pattern and distribution of colorectal diverticulosis: A cross-sectional study in Southern China","fulltext":[{"header":"Background","content":"\u003cp\u003eDiverticulosis is a condition that occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon. The etiology and pathogenesis of colorectal diverticulum are not completely clear. Risk factors, such as age, gender, diet, physical activity, genetic factors, colorectal immobility, weakening of the colorectal wall, low-grade inflammation, and imbalances in microflora, play crucial roles in the development of diverticulum [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Its symptoms are often atypical, easy to misdiagnosis, and can also lead to local inflammation, abscess formation, intestinal obstruction, bleeding, perforation, internal fistula, and other related complications, seriously endangering the health of patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Diverticular diseases and their complications pose a substantial burden on worldwide healthcare systems. It is the eleventh most common outpatient diagnosis in the United States, with 207,150 as the principal diagnosis from hospital admissions at a cost of \u003cspan\u003e$\u003c/span\u003e9.0\u0026nbsp;billion in 2018 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWorldwide, the prevalence of CD is rising. In industrialized nations like the United States and the United Kingdom, rates may fluctuate from 42% to 51.6% [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. There has been a consistent increase in the incidence of CD in several Asian countries as they age and increasingly embrace a more westernized lifestyle. For instance, Nagata et al [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] observed that the proportion of CD increased from 18% in 2003 to 23% in 2011.\u003c/p\u003e \u003cp\u003eThe incidence of CD in China is significantly lower than in occidental nations. However, as China's social economy developed, the country's aging population became more problematic, medical standards improved, and growing affluence and globalization caused traditional lifestyles to shift toward a more westernized way of living. Recently, a colonoscopy-based survey from Northern China demonstrated 3.8% prevalence of CD, with a yearly increase in trends [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Yet, literature regarding the prevalence of CD in mainland China is sparse, obsolete, and localized. Besides, there are huge differences between Northern and Southern China.\u003c/p\u003e \u003cp\u003eTherefore, we conducted a retrospective of one single center observation study of patients undergoing colonoscopy in our endoscopy center within the last 3 years. The aim of this research is to describe the characteristics and distribution of CD in Southern China while increasing Chinese clinicians' awareness of CD.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eSubjects\u003c/p\u003e \u003cp\u003eThis cross-sectional study examined colonoscopy results from Nanchang University's first affiliated hospital in retrospect. The research was carried over the period January 1, 2021, to December 31, 2023. There were established age groups: \u0026le;40, 41\u0026ndash;50, 51\u0026ndash;60, 61\u0026ndash;70, \u0026gt;\u0026thinsp;70 years. Patients under 18 years old, foreign nationals, those with failed adequate bowel preparation or complete colonoscopy, repeat colonoscopy during the study period, and patients with colectomy or inflammatory bowel disease were excluded.\u003c/p\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003cp\u003eEach colonoscopy was conducted by at least two well-trained endoscopists in our endoscopy center. The results of colonoscopies were methodically examined and manually entered into a computer system for further examination. Before the exam, the bowel was prepared with a 3 L solution that contained polyethylene glycol electrolyte powder. The anatomical locations of CD were documented into the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Diverticula were classified into two locations: right-side (which included any diverticula reported in the cecum, ascending, and transverse colon), and left-side (which included any diverticula reported in the descending sigmoid and rectum colon).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003ePercentages were computed for categorical data. Age groups were created (\u0026le;\u0026thinsp;40, 41\u0026ndash;50, 51\u0026ndash;60, 61\u0026ndash;70, \u0026gt;\u0026thinsp;70 years). To estimate odds ratios and 95% confidence intervals while adjusting for potential confounders (age, sex, and location), a binomial multivariate logistic regression analysis was performed. The odds of CD by sex within each age group were modeled. In all two-tailed tests of significance, p-values less than 0.05 were considered statistically significant. The analysis was conducted using SPSS version 27.0 for Windows (SPSS Inc.).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, a total of 56308 patients (25686 male and 30622 female) were included. 2954 (5.25%) had CD, 1716 male and 1238 female. We also assessed the location, and complication. However, only 1 case combined with bleeding and 2 cases combined with inflammation; 53 cases combined with intra-diverticular fecal impaction; and no intestinal perforation were observed in this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePatients with CD have a mean age of 53.2 and are statistically older than those without CD (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). According to our data, the prevalence of CD increased with age. Patients over 70 exhibited a prominent increase of CD in comparison to those under 40. (OR 3.41, 95% CI 2.89\u0026ndash;4.03). Interestingly, the majority of diverticulosis was located in the cecum and ascending colon with 53.6%, 50.6%. Only 8.2% were in the transverse colon, 6.1% in the descending colon, 7.1% were in the sigmoid colon, and 2.8% were in the rectum (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristic of Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge(y), Mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ewithout CD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003csup\u003e\u0026dagger;\u003c/sup\u003e (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.2(13.3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.2(12.4)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.9(13.3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16037(28.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e468(15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15569(29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14832(26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e695(23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14137(26.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.74(1.54,1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15725(27.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e992(33.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14733(27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.43(2.17,2.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7255(12.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e579(19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6676(12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.11(2.74,3.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2459(4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e220(7.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2239(4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.41(2.89,4.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30622(54.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1238(41.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23970(44.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25686(45.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1716(58.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29384(55.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.83(1.69,1.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e\u0026dagger;\u003c/sup\u003eComparison between those without CD and those with CD.\u003c/p\u003e \u003cp\u003eCD, colorectal diverticulosis; OR, odds ratio; CI, confidence interval.\u003c/p\u003e \u003cp\u003eCD was observed with a prevalence of 6.68% (1716/25686) in males, compared to 4.04% (1238/30622) in females. There was a notably male predominance in CD (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). However, when stratified by age, the prevalence of CD in both male and female was increased with age under 70 years old. The prevalence of CD in males was slightly decreased with age over 70 years old, while females were opposite (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Females were significantly more susceptible than males to develop CD after the age of 70 (OR 1.35, 95% CI 1.02\u0026ndash;1.79) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence and Adjusted Odds of CD by Sex Within Age Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevalence of CD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003csup\u003e\u0026dagger;\u003c/sup\u003e (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.93%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44(0.36,0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.96%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.41(0.35,0.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50(0.44,0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.09%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75(0.63,0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.09%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.35(1.02,1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e\u0026dagger;\u003c/sup\u003eComparison between those males with CD and females with CD in the same age group.\u003c/p\u003e \u003cp\u003eCD, colorectal diverticulosis; OR, odds ratio; CI, confidence interval.\u003c/p\u003e \u003cp\u003eWe further assessed the location of CD. Regarding contrast with left-sided CD (318 cases; 0.56%), we found a greater prevalence of right-sided CD (2772 cases; 4.92%) in our study. Interestingly, those with right-sided CD often had a lower age of 8.64 years compared to those with left-sided CD (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence and OR of CD Location by Sex, Age Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eleft-side\u003c/p\u003e \u003cp\u003e0.56%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR\u003csup\u003e\u0026dagger;\u003c/sup\u003e (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eright-side\u003c/p\u003e \u003cp\u003e4.92%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR\u003csup\u003e\u0026Dagger;\u003c/sup\u003e (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.74(1.39,2.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.31%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.85(1.71,2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.06%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.87%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(Reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.89(1.92,7.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.70(1.51,1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.37(6.47,23.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.89%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.30(2.05,2.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.38(12.72,46.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.86(2.51,3.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.58(21.25,81.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.52%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.87(2.40,3.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(y)\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.4(10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.8(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e\u0026dagger;\u003c/sup\u003eComparison between those without diverticulosis and those with left-colonic diverticulosis.\u003c/p\u003e \u003cp\u003e \u003csup\u003e\u0026Dagger;\u003c/sup\u003eComparison between those without diverticulosis and those with right-colonic diverticulosis.\u003c/p\u003e \u003cp\u003eCD, colorectal diverticulosis; OR, odds ratio; CI, confidence interval.\u003c/p\u003e \u003cp\u003eIn the multivariate logistic regression analyses, it was determined that patients aged in 41\u0026ndash;50, 51\u0026ndash;60, and 60\u0026ndash;70 years with right-sided CD had a significantly higher likelihood (OR: 1.70, 2.30, and 2.86) of being aged\u0026thinsp;\u0026le;\u0026thinsp;40 years. However, the prevalence of right-side CD did not consistently increase with age over 70 years old. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When separated by sex, the prevalence of right-sided CD declined in male patients aged over 70 years, which resulted in the decline of the prevalence of CD in males as above mentioned. Conversely, patients with left-sided CD regardless of gender were found to have a continuous increase with all age groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn retrospectively analyzing the characteristics of colonoscopy patients at our institution, we found that the prevalence of CD in Southern China was 5.25%. However, colonoscopy can miss half of CD compared with barium enema [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Besides, the ignorance of CD in Chinese physicians further contributes to the potential underestimation of the prevalence of CD in our study.\u003c/p\u003e \u003cp\u003eConcerning the prevalence of CD in China, Pan et al [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] first observed that the incidence of CD, as judged from the necropsy cases and colonoscopy cases, was 0.12% and 0.33%-1.2% from 1921\u0026ndash;1985; Yang et al [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] demonstrated that the incidence of CD has risen from 2.78% in 2011 to 4.98% in 2015. Yan et al [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] determine that the incidence of CD was 7.3% in Eastern China in 2020. Our result of 5.25% of the incidence of CD appears to be rational because our data show that the prevalence of CD increased from 5.94% to 8.41 in 2021 to 2023.\u003c/p\u003e \u003cp\u003eThe complication of CD in this group was only 1.86% (55/2954) cases, which is much lower than that reported in the literature [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This may be related to the fact that patients with acute diverticulitis in this institute are not recommended to have colonoscopies due to potential risks associated with the surgery, particularly the higher risk of local or distant perforation, though this policy was lack of evidence [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It is recommended 4\u0026ndash;6 weeks following an episode of acute diverticulitis to confirm CD and exclude out colorectal cancer [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, some evidence demonstrated that the risk of malignancy after a CT-proven uncomplicated diverticulitis is low [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCD is associated with increasing age. According to Peery et al [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] the incidence increased from \u0026lt;\u0026thinsp;13.70% in patients under 40 years old to \u0026gt;\u0026thinsp;57.43% in individuals over 60. Patients with CD (mean age: 53.24) in this study were considerably older than those without it (mean age: 47.89, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The extended duration of connective tissue exposure to intestinal contents may be the cause of this condition, since it increases susceptibility to different pathogenetic variables that may lead to diverticulosis [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. China's growing aging population is currently posing issues. By 2050, the number of elderly people in China is predicted to surpass 400\u0026nbsp;million, making up 30% of the country's total population [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In part, the new study's findings support the notion that CD rates may continue to rise for many years in China.\u003c/p\u003e \u003cp\u003eMales were more likely to develop CD in any location compared with females in this study. As we stratified patients by age and colonoscopy site, the right-side CD in males decreased in individuals aged over 70 years old (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). As we all know, CD cannot be self-cured, but we believe it might contribute to the development of the economy since the economy reform in 1978. The adaptation to western lifestyle and diet accelerates the form of CD.\u003c/p\u003e \u003cp\u003eMoreover, our data reveal that the elder female was more susceptible to CD. The OR value gets the bottle line at the age of 41\u0026ndash;50 and rebounded with the age increase, which is just about menopausal age (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). According to Peery's research, CD was less prevalent in females compared with males before the usual menopausal age [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This trend declined as women aged, suggesting that sex hormones may have an impact on etiology. According to our data, endogenous ovarian steroid hormones may lower the chance of CD.\u003c/p\u003e \u003cp\u003ePrior studies have consistently demonstrated that, in contrast to the higher incidence of right-sided CD seen in Asian countries, left-sided CD is more prone in western countries [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In the United States, 72% of CD were in the sigmoid colon, 1\u0026thinsp;~\u0026thinsp;11% were in the cecum, and ascending colon in the United States [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, 32.1% of CD were in the sigmoid colon, 29.6%~62.7% were in the cecum and ascending colon in Thailand [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Our research shows that 7.1% of CD was in sigmoid, 53.6%, and 50.6% were in the cecum and ascending. Additionally, Nakaji [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] et al. also find that Japanese-Americans living in Hawaii with Western diets and lifestyles still maintain a predominance of right-sided CD. This observation presents credence to the theory that CD is influenced by genetics in addition to diet and lifestyle.\u003c/p\u003e \u003cp\u003eInterestingly, the location of the CD was linked to age, according to our research. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that patients under 60 years old are more likely to develop right-sided CD (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). While left-sided CD were seldom observed in patients under 60, they were frequently developed in those over 60 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additional research has also supported the found connection. For example, W. Hong et al. found that right-sided CD do not increase in incidence in those over 60, while left-sided CD are more prevalent into the eighth decade. Certain individuals propose that CD on the right side could be innate, while those on the left side could develop as a result of elevated intestinal pressure brought on by a low-fiber diet, luminal blockage, and contraction [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Furthermore, in line with our findings, Jensen's study proposed that CD advances with aging from the right-side colon to the left-sided colon. According to N. Isohata et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] patients first experience diverticula on the right side of the colon, which eventually spread to the left as they age.\u003c/p\u003e \u003cp\u003eThere are limitations on our work. First of all, considering it's a single center with cross-sectional and retrospective analysis. The results of the present study require confirmation by a prospective study. Second, the participants in our study were from the southern Chinese city of Nanchang. Since dietary habits and lifestyles might range greatly throughout Chinese regions, our results might not be indicative of China as a whole [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Additionally, the mechanism behind the location and characteristic of CD was not examined in this study. Comprehensive research will be conducted in the future.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur research based on the 56308 colonoscopy patients for 3 years indicated that the prevalence of CD is 5.25% in China. CD is primarily found on the right side in China, is more common in males, and is correlated with age. Notably, CD was more common in females over 70 years. Patients with left-sided CD are typically older than left-sided.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eData availability statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eFunding statement: No funding\u003c/p\u003e\n\u003cp\u003eDeclaration of conflict of interest: All authors declare that there is no conflict of interest or financial support relevant to this study.\u003c/p\u003e\n\u003cp\u003eEthics approval and informed consent:\u0026nbsp;All participants were collected from the First Affiliated Hospital of Nanchang University. This study was approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University (IIT2025003) and was performed in accordance with the Declaration of Helsinki. This study was registered at Chinese Clinical Trial Registry (Chictr.org.cn, ChiCTR2500097648, 2025/02/24), All participants gave written informed consent as evidenced by the participants’ signature.\u003c/p\u003e\n\u003cp\u003eAuthors’ contributions: ZJH and XQC contributed equally to this work including designed the research, analyzed the date, wrote the paper; YZ performed the research; JL, XDZ and BW revised the paper. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: The authors appreciate the colleagues in the Nanchang University and Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University Hospital. We also appreciate the participants of subjects.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, et al. Colonic diverticular disease. 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China CDC Wkly. 2021;3:593\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeery AF, Keku TO, Galanko JA, Sandler RS. Sex and Race Disparities in Diverticulosis Prevalence. Clin Gastroenterol Hepatol. 2020;18:1980\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamamichi N, Shimamoto T, Takahashi Y, Sakaguchi Y, Kakimoto H, Matsuda R, et al. Trend and risk factors of diverticulosis in Japan: age, gender, and lifestyle/metabolic-related factors may cooperatively affect on the colorectal diverticula formation. PLoS ONE. 2015;10:e0123688.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang FW, Chuang HY, Tu MS, King TM, Wang JH, Hsu CW, et al. Prevalence and risk factors of asymptomatic colorectal diverticulosis in Taiwan. 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J Clin Gastroenterol. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/MCG.0000000000001980\u003c/span\u003e\u003cspan address=\"10.1097/MCG.0000000000001980\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRecent trends in. the prevalence and distribution of colonic diverticula in Japan evaluated using computed tomography colonography - PMC. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316905/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316905/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 14 Sep 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe J, Gu D, Wu X, Reynolds K, Duan X, Yao C, et al. Major causes of death among men and women in China. N Engl J Med. 2005;353:1124\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"colorectal diverticulosis, colonoscopy, distribution, age, gender","lastPublishedDoi":"10.21203/rs.3.rs-9533147/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9533147/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eColorectal diverticulosis (CD) is easy to ignore in China for its low morbidity compared to western countries. However, the incidence of CD is rising in China, which might relate to the aging population and gradual westernization of lifestyle. Our study aims to determine the incidence, location, and sex differences associated with CD.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePatients who underwent colonoscopy at Nanchang University's first affiliation hospital between January 1, 2021, and December 31, 2023 were analyzed. All CD encountered during the procedure was evaluated and documented. The distribution of CD was classified as left-sided and/or right-sided. The associations between CD and participant characteristics were analyzed using logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 56308 eligible patients from our endoscopy database were included. 2954 individuals (5.25%) were identified with CD. Patients with CD had a mean age of 53.2 years old and were notably older, with a higher proportion of males compared to those without CD. Females were significantly more susceptible than males of the same age to have CD after the age of 70 (OR 1.35, 95% CI 1.02\u0026ndash;1.79). The number of patients with right-sided and left-sided CD ranged from 2772 (4.92%) to 318 (0.56%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn Southern China, CD most frequently affects the right side and is more common in old males. Women over 70 years of age are more prone to developing CD. Patients with left-sided CD generally tend to be older than those with right-sided CD.\u003c/p\u003e","manuscriptTitle":"Pattern and distribution of colorectal diverticulosis: A cross-sectional study in Southern China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-18 05:53:57","doi":"10.21203/rs.3.rs-9533147/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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