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  • Jefferson Adams
    Jefferson Adams

    400% Increase in Risk of Death for Undiagnosed Celiacs

    Reviewed and edited by a celiac disease expert.

    Celiac.com 04/22/2009 - Not many studies have looked at prevalence and long-term outcome of undiagnosed celiac disease, and so not much is known about this aspect of the disease. Recently, a team of Mayo Clinic researchers conducted an assessment of the long-term outcome of undiagnosed celiac disease, and whether the prevalence of undiagnosed celiac disease has changed during the past 50 years.

    The research team was made up of Alberto Rubio-Tapia, MD; Robert A. Kyle, MD; Edward L. Kaplan, MD; Dwight R. Johnson, MD; William Page, PhD; Frederick Erdtmann, MD, MPH; Tricia L. Brantner, MD; W. Ray Kim, MD, Tara K. Phelps, MS; Brian D. Lahr, MS; Alan R. Zinsmeister, PhD; L. Joseph Melton III, MD; and Joseph A. Murray, MD.

    For the study the team looked at blood samples taken from 9,133 healthy young adults at Warren Air Force Base between 1948 and 1954, along with samples from 12,768 sex-matched subjects from 2 recent cohorts from Olmsted County, Minnesota. Subjects from the Minnesota cohorts were matched for date of birth (n=5,558) or age at sampling (n=7,210) with the Air Force study.

    The research team tested the blood samples for tissue transglutaminase and, if abnormally high, for endomysial antibodies. They charted survival rates in a 45 year follow-up period in the Air Force and compared rates of undiagnosed celiac between the Air Force data and the recent cohorts.

    Of 9,133 Air Force subjects, 14 had undiagnosed celiac disease--a rate of 0.2%. In that cohort, persons with undiagnosed celiac disease had higher mortality rates across the board than those who had tested negative (hazard ratio=3.9; 95% CI, 2.0-7.5; P <.001).

    In the case of the Minnesota cohorts, the team found undiagnosed celiac disease in 68 persons with similar age at sampling (0.9%), and 46 persons with similar years of birth (0.8%). These recent cohorts showed rates of undiagnosed celiac disease that were 4.5-times and 4-times greater than the Air Force cohort (both P=.0001).

    The research team found that data from the 45 year of follow-up of Air Force subjects showed that people with undiagnosed celiac disease have a 400% higher risk of death than seronegative subjects ("non-celiacs"). They also concluded that rates of undiagnosed celiac disease seem have increased dramatically in the United States over the last 50 years.

    Gastroenterology - 13 April 2009 (10.1053/j.gastro.2009.03.059).


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    Guest Jefferson Adams

    Posted

    The key data point from the study is here:

     

    'Of 9,133 Air Force subjects, 14 had undiagnosed celiac disease--a rate of 0.2%. In that cohort, persons with undiagnosed celiac disease had higher mortality rates across the board than those who had tested negative (hazard ratio=3.9; 95% CI, 2.0-7.5; P <.001). '

    The researchers followed the group over a 45 year span and in every case, they showed earlier mortality than their non-celiac counterparts. They also corroborated and adjusted their numbers in accordance with a related study:

     

    'In the case of the Minnesota cohorts, the team found undiagnosed celiac disease in 68 persons with similar age at sampling (0.9%), and 46 persons with similar years of birth (0.8%). These recent cohorts showed rates of undiagnosed celiac disease that were 4.5-times and 4-times greater than the Air Force cohort (both P=.0001).'

     

    The reasons for increased mortality rates are likely due to the degenerative effects of undiagnosed celiac disease--excess cancers, nutritional deficiencies, other associated conditions, etc. The study didn't get into the 'Whys,' just the fact that mortality rates are higher--meaning undiagnosed celiacs die younger than those without celiac disease (specifically, if you have undiagnosed celiac disease, over the 45 year period in question, you would die earlier than 400 comparable people without celiac disease 100% of the time--follow? So if you compared 10 celiacs to 4000 non-celiacs, or 100 celiacs to 40000 non-celiacs, the celiacs would ALL die before the non-celiacs--for whatever reasons).

     

    They also note that with increased diagnosis and treatment trends, that this reality is changing. Fewer people will go through life with undiagnosed celiac disease, and so more people will live longer than they would have otherwise.

     

     

    -J.A.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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