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High Rates of Celiac Disease and Detection in Finland

Celiac.com 07/31/2009 - Worldwide, most people with celiac disease remain undiagnosed and untreated, oblivious to their increased risk of mortality, and of developing certain cancers and other celiac-related conditions.

Finland has set out to achieve high detection rate by training health personnel, and advocating blood tests for people known to be at risk for developing celiac disease.

A team of researchers recently set out to determine whether this approach has been clinically effective in practice. The research team was made up of Lauri J. Virta, Katri Kaukinen & Pekka Collin.

Since 2002, Finland's Social Insurance Institution had paid monthly compensation to people with newly diagnosed celiac disease for the additional cost of maintaining a gluten-free diet. To receive this compensation, people must submit proof of diagnosis, including biopsy findings, along with diagnostic criteria, in a statement from a physician. That information is kept in a national database. The researchers used the database to calculate incidence and prevalence rates of celiac disease through 2006.

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From the database, they selected from a total population aged 16 years or older of 4.31 million, to identify a total of 5020 persons (64% female) who received a new dietary grant in 2004-06. Altogether, 23,553 persons received the dietary grant. Thus, the mean annual incidence of proven celiac disease to be 39 per 100,000 individuals.

This puts the national prevalence of adult celiac disease in Finland at 0.55% (0.70% F, 0.38% M). The results varied by region from 33 to 49 per 100,000 in annual incidence, and from 0.41% to 0.72% in the prevalence rates.

It seems these figures for proven celiac disease in Finland are the highest yet charted. Nevertheless, many celiac disease cases remain undetected, as the true prevalence in Finnish adults is about 1.5-2.0%. Increased alertness to the condition and active case finding has made this efficient diagnostics possible.

Interestingly, people aged 65 to 74 years showed the highest prevalence; in females prevalence peaked at 1.10% (95% Cl: 0.98-1.23) at the age of 68 years and in males, 0.77% (95% CI: 0.67-0.89), also at 68 years. Also, earlier findings have shown that 10-15% of cases will be detected because of atypical symptoms or associated conditions.

Scandinavian Journal of Gastroenterology, 2009; 44: 933-938

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