Pediatric Celiac Disease Diagnoses Tripled in 20 Years

Ricki Lewis, PhD

January 23, 2015

The number of children diagnosed with celiac disease in the United Kingdom has almost tripled during the last 2 decades, but economically disadvantaged youngsters were only half as likely to be diagnosed, according to a report published online January 22 in the Archives of Disease in Childhood.

Seroprevalence of celiac disease is about 1% in the US and Western European pediatric populations, but biopsy-based diagnosis indicates an increase in prevalence. If the increase reflects improved ascertainment from screening programs, more clinical awareness, and better available diagnostic testing, then higher socioeconomic groups might be expected to have a higher diagnostic rate than groups at the other end of the spectrum who have less access to healthcare.

Fabiana Zingone, MD, from the Division of Epidemiology and Public Health at the City Hospital Campus of the University of Nottingham, United Kingdom, and colleagues analyzed information on children younger than 18 years listed in The Health Improvement Network, a national database of primary care health records spanning 1993 through 2012. The authors' goal was to investigate patterns of diagnosis for celiac disease.

Of 2,063,421 children in the database for the period examined, 1247 were diagnosed with celiac disease, for an overall incidence of 11.9 per 100 000 person-years. The overall diagnosis rate from 2008 to 2012 was 75% higher than it was from 1993 to 1997 (incidence rate ratio [IRR], 1.75; 95% confidence interval [CI], 1.31 - 2.34). Much of the increase was seen for children older than 2 years, among whom diagnosis rate nearly tripled.

When the researchers split the population by sex, they saw a clear increase in both boys and girls between the earliest period, 1993 to 1997, and the latest, 2008 to 2012. Specifically, diagnoses increased by 39% among boys (IRR, 1.39, 95% CI, 0.92 - 2.10) and by slightly more than twofold among girls (IRR, 2.09; 95% CI, 1.39 - 3.13).

The analysis revealed a "gradient of [celiac disease] diagnosis across socioeconomic groups, with the rate of diagnosis being 80% higher in children from the least-deprived areas than in those from the most-deprived areas ([IRR] 1.80, 95% CI 1.45 to 2.22)." The association of poverty with fewer celiac disease diagnoses held for both sexes and for all ages in all four nations of the United Kingdom.

The researchers attribute the difference in celiac disease diagnosis rate to greater opportunities for diagnosis among the well-off. They discount the hygiene hypothesis as protecting children from poor backgrounds because early infections are a risk factor for celiac disease. In addition, they note that too little is known about the gluten composition of diets across socioeconomic backgrounds to conclude that nutrition plays a role in susceptibility. They also discount influence from exclusive breast-feeding, which is less common in lower socioeconomic strata.

A limitation of the study is that it identifies an association between socioeconomic status and likelihood of celiac disease diagnosis but cannot reveal the causes.

"Awareness campaigns and the implementation of diagnostic guidelines may help to implement strategies for case-finding in all children and reduce this inequality," the researchers write.

The study was supported by CORE/Coeliac UK. The authors have disclosed no relevant financial relationships.

Arch Dis Child. Published online January 22, 2015. Full text


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