The Incidence and Risk of Celiac Disease in a Healthy US Adult Population

Mark S. Riddle, MD, DrPH; Joseph A. Murray, MD; Chad K. Porter, PhD

Disclosures

Am J Gastroenterol. 2012;107(8):1248-1255. 

In This Article

Results

As shown in Table 1, a total of 455 cases of incident CD were identified in active duty US military personnel between 1999 and 2008 with an overall incidence of 3.55 per 100,000 person-years (p-yrs) (95% confidence interval (CI): 3.24, 3.90; Table 1). Rates were higher in females (7.70 per 100,000 p-yrs) compared with males (2.78 per 100,000 p-yrs) (P<0.001). Incidence for CD was noted to rise from 1.32 per 100,000 p-yrs in 1999 to 6.54 per 100,000 p-yrs in 2008, and this rise was highest in the older age strata (Figure 1). While incidence increased at a higher rate per annum in whites, those classified as other race (i.e., non-white and non-black) also showed year-over-year increases of ~0.8 per 100,000 per year.

Figure 1.

Incidence of celiac disease in US military stratifi ed by age group, 1999–2008.

The majority of cases and controls were male (65.9%), white (66.4%), and married (69.4%) (Table 2). Cases were noted to have education beyond high school (54.7%), which was higher than controls (45.8%) (P<0.001). The three major branches of the US Military Armed Forces (Army, Navy, and Air Force) comprised the majority (88.6%) of the study population, with most classified as enlisted personnel, though a higher proportion of officers were noted among CD cases compared with controls (32.5 vs. 22.1%, P<0.001). Overlap with functional and other gastrointestinal disorders were assessed among cases and included dyspepsia (8/455, 1.8%), constipation (10/455, 2.2%), irritable bowel syndrome (20/455, 4.4%), and functional diarrhea (4/455, 0.9%). There was no overlap with gastroesophageal reflux disease. Overall, 38 (8.4%) had one or more visit associated with these gastrointestinal disorders. One-hundred seventy-two subjects had one or more IGE exposures with etiological category distributed as follows: bacterial pathogens (n=4, 2.3%), protozoal (n=2, 1.2%), viral (n=104, 60.5%), and other (n=74, 43.0).

Among incident CD cases followed, the median number of visits was two (interquartile range: 2, 4) with no significant difference based on exposure. Data were not available on the proportion of CD cases that resulted in discharge from medical service, though this is often known to occur in these cases (personal communication, Brooks Cash, US Navy).

Initial univariate analyses (Table 3) found that the following covariates were independently associated with an increased risk of CD: Caucasian race, non-Army branch of service, greater than high-school education, and previous IGE episode. Prior deployment to Operation Iraqi Freedom deployment had lower risk of CD compared with non-Operation Iraqi Freedom deployers. The odds ratio (OR) for incident CD following an antecedent episode of IGE increased as the time frame allotted for exposure decreased. When limiting the IGE episodes to only those of non-viral origin in the 24 months before censure, the associated OR increased for CD. In a multivariate model, after controlling for the other covariates, being married, having less than a Bachelor's Degree, being in the Army, having an episode of IGE in the 24 months before censure significantly increased the risk of each functional gastrointestinal disorder (FGD) (Table 4). In contrast, being in the Marines appeared to be protective (Navy referent). Being classified as non-Caucasian decreased the risk of CD.

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