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Celiac disease among young children nearly tripled in UK since 1993
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Clinical diagnoses of celiac disease among children older than 2 years have increased nearly threefold during the past 2 decades in the United Kingdom, primarily in less socioeconomically deprived areas, according to new research data.
“Over the last decades there has been increased clinical awareness of celiac disease partially because of improvements in the accuracy and availability of diagnostic tests,” Laila J. Tata, PhD, associate professor of epidemiology from the School of Medicine at University of Nottingham, told Healio Gastroenterology. “However, we did not have current estimates of actual celiac disease diagnoses in children and it is important to know whether diagnostic patterns vary by socioeconomic group.”
Laila J. Tata
Aiming to identify socioeconomic variations of clinical diagnosis of pediatric celiac disease, Tata and colleagues identified all children aged 0 to 18 years registered with a general practice that contributed to a large population-based database (The Health Improvement Network) between 1993 and 2012. Celiac disease incidence rates (IRs) were calculated and stratified by age, sex, country of residence, calendar year and household socioeconomic quintile.
A total of 2,063,421 children were included (10,508,374 person-years) with a median follow-up period of 3.8 years (interquartile range , 1.5-7.9) and 1,247 celiac disease diagnoses (overall IR=11.9; 95% CI, 11.2-12.5 per 100,000 person-years). The rate of celiac disease was 53% higher in girls (IR ratio [IRR]=1.53; 95% CI, 1.37-1.72). Incidence was lowest in children younger than 1 year (IR=4; 95% CI, 2.7-6), after which it increased at age 1 (IR=18.7; 95% CI, 15.7-22.2) and age 2 years (IR=17.9; 95% CI, 15-21.5). Incidence was then lower from age 3 (IRR=8.4; 95% CI, 11.3-17.1) to 18 years (IRR=11.9; 95% CI, 9.2-15.5). Diagnosis rate increased by 75% in the last 5 years of the study period compared with the first 5 years (IRR=1.75; 95% CI, 1.31-2.34).
Throughout the study period, there was a 39% increase in diagnoses in boys (IRR=1.39; 95% CI, 0.92-2.1) and the incidence in girls doubled (IRR=2.09; 95% CI, 1.39-3.13). Diagnoses remained consistent in children younger than 2 years (IRR=0.77; 95% CI, 0.5-1.18), but it tripled in children older than 3 years from the first 5 years compared with the last 5 years (children aged 3-9 years; IRR=2.85, 95% CI, 1.66-4.88; and age 10-18 years; IRR=3.24, 95% CI, 1.6-6.56).
The investigators also found a gradient in celiac disease diagnoses across socioeconomic groups, with the highest incidence in children from the two least socioeconomically deprived quintiles (IRR=1.8; 95% CI, 1.45-2.22; and IRR=1.85; 95% CI, 1.48-2.3, respectively), and the lowest incidence in the most deprived quintile. This trend was consistent across sexes, age groups, time period and country of residence.
“Clinicians should ensure they implement the most recent diagnostic guidelines and procedures to obtain a diagnosis of celiac disease,” Tata said. “The gap in childhood diagnosis between the most and least socioeconomically deprived children could be due to different risk factors predisposing them to celiac disease; however, there is limited evidence for this thus far. Another likely possibility is that ascertainment of disease varies, so awareness campaigns for clinicians and the general population may help to implement strategies for case-finding in all children and reduce this inequality.” — by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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