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Celiac disease prevalence in US highest among Punjabi Indians
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Compared with other ethnic groups in the United States, individuals from the Punjab region of India were found to have the highest prevalence of celiac disease in a cross-sectional study of patients who underwent duodenal biopsy.
“In this analysis of duodenal biopsy specimens performed throughout the United States, we found that the prevalence of villous atrophy (the hallmark of celiac disease) is highest among those of Punjabi Indian ancestry, which is consistent with recent studies coming out of India showing that there are major regional differences in celiac disease,” Benjamin Lebwohl, MD, MS, Herbert Irving Assistant Professor of Medicine and Epidemiology at the Celiac Disease Center at Columbia University Medical Center in New York City told Healio Gastroenterology.
Using records from a large national pathology database, Lebwohl and colleagues identified 454,885 patients (median age, 53 years; 66% women) who underwent esophagogastroduodenoscopy with duodenal biopsy from January 2008 through April 2015. They used a validated computer algorithm based on patient names to stratify patients by ethnicity: North Indian (further stratified into Punjabi or other), South Indian, East Asian, Hispanic, Middle Eastern, Jewish (further stratified into Ashkenazi or Sephardic) and other Americans (mostly Caucasians and African Americans). Then they calculated the prevalence of villous atrophy among each group.
Overall, 7,928 patients had villous atrophy consistent with celiac disease, corresponding to a 1.74% overall prevalence. Compared with the prevalence of celiac disease among other Americans (n = 380,163; 1.83%), prevalence was lowest in patients of South Indian (n = 177; 0%; P = .08), East Asian (n = 4,700; 0.15%; P <.0001) and Hispanic ethnicities (n = 31,491; 1.06%; P < .0001).
There was a trend toward higher prevalence among North Indians (n = 1,195; 2.04%) compared with other Americans (1.83%; P = .06), but this did not reach statistical significance. However, celiac disease was more common in patients from the Punjab region (n = 617; 3.08%) compared with others from North India (1.51%; P = .02).
“This is also the first study to examine the prevalence of this condition among Jewish patients in the United States; in contrast to the known greater prevalence of inflammatory bowel disease in this group, we found that Jewish individuals did not have a higher prevalence of celiac disease compared to the general population,” Lebwohl said.
The prevalence of celiac disease among Jewish (n = 17,806; 1.8%; P = .78) and Middle Eastern patients (n = 1,903; 1.52%; P = .33) was comparable to that of other Americans, and among Jewish patients the prevalence was 1.83% in Ashkenazi individuals (n = 16,440) and 1.39% in Sephardic individuals (n = 1,366; P = .24).
“Finally, we found that, regardless of ethnicity, celiac disease was equally common in men and women undergoing duodenal biopsy, refuting the notion that celiac disease is primarily a female disease.”
Although 67% of patients with celiac disease were women, this was due to the fact that 66% of those who underwent duodenal biopsy were women, and the prevalence of celiac disease was 1.7% in men vs. 1.8% in women, the researchers wrote. However, “there was a nonsignificant trend toward female predominance in North Indian, Hispanic, Middle Eastern and Jewish patients.”
“Our findings help shed light on the distribution of celiac disease in the U.S. and will aid gastroenterologists in diagnosing their patients,” Lebwohl said in a press release. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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