A261 INCIDENCE OF CELIAC DISEASE IS INCREASING OVER TIME: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background

The prevalence of celiac disease is estimated to be approximately 1%. However, the rate at which diagnoses have changed over time remains unknown.

Aims

To analyze the incidence of celiac disease across time.

Methods

We performed a systematic review in MEDLINE and EMBASE up to 2018, to identify all population-based studies reporting the incidence of celiac disease (n = 47). Temporal trend analyses captured the average annual percent change (AAPC) in celiac disease incidence over time. Meta-analyses were performed using random-effects models to determine sex and age differences in celiac disease incidence in the 21 ^st century, as well as temporal trends (AAPCs) from 1990 to 2016. Heterogeneity was assessed using the I ² statistic.

Results

In the 21 ^st century, the pooled female incidence of celiac disease was 17.4 (95% CI: 13.7, 21.0) per 100,000 person-years, compared to 7.8 (95% CI: 6.3, 9.3) in males. Child-specific incidence was 20.1 per 100,000 person-years (95% CI: 16.0, 24.3) compared to 13.2 (95% CI: 8.6, 17.8) in adults. Incidence of celiac disease appeared to be relatively low and stable until the 1990s (Figure 1), wherein diagnoses started to increase annually at 8.4% (95% CI: 6.0, 10.8) per year (Table 1).

Conclusions

The incidence of celiac disease is significantly rising. Celiac disease is disproportionately diagnosed in females and children, respectively.

Table 1: Pooled AAPC of celiac disease incidence from 1990 to 2016

Study (Country)	Time Period	AAPC (95% CI)
Cook 2004 (New Zealand)	1990–1999	19.9 (13.5, 26.8)
Fowell 2006 (UK, England)	1993–2002	11.4 (2.4, 21.1)
Hawkes 2000, Hurley 2012 (UK, Wales)	1990–2005	10.5 (8.7, 12.3)
McGowan 2009 (Canada)*	1990–2006	9.9 (0.6, 20.1)
Fernandez 2010 (Spain)^	1990–2008	25.3 (14.2, 37.5)
Namatovu 2014 (Sweden)*	1990–2009	2.5 (-5.8, 11.6)
Lanzarotto 2004, Lanzini 2005 (Italy)	1996–2003	18.2 (12.8, 23.8)
Ress 2012 (Estonia)*	1990–2010	8.2 (3.1, 13.5)
Jansen 1993, Burger 2014 (Netherlands)	1990–2010	9.3 (8.2, 10.3)
Murray 2003, Ludvigsson 2010 (USA)	1990–2010	8.1 (4.6, 11.7)
West 2014 (UK, Nationwide)	1990–2011	5.5 (4.6, 6.5)
Tapsas 2015 (Sweden)*	1990–2013	2.6 (1.0, 4.3)
Perminow 2000, Beitnes 2017 (Norway)*	1993–2010	8.7 (-27.2, 62.3)
Dydensborg 2012 (Denmark)*	1996–2009	12.8 (7.2, 18.6)
Zingone 2015b (UK, Nationwide)*	1993–2012	3.9 (1.9, 6.0)
Rajani 2010 (Canada)*	1998–2007	60.8 (34.4, 92.4)
Grode 2018 (Denmark)	1990–2016	7.8 (6.9, 8.7)
White 2013, Lister 2018 (Scotland)*	1990–2016	12.8 (11.4, 14.1)
Holmes 2017 (UK, England)^	1994–2014	7.8 (-0.5, 16.8)
Angeli 2012 (Italy)	2002–2010	-1.5 (-7.8, 5.2)
Stewart 2011 (Canada)	2004–2008	10.2 (-0.9, 22.5)
Kivela 2015 (Finland)*	2001–2013	3.3 (-0.9, 7.8)
Whyte 2013 (UK, Wales)*	2005–2011	5.8 (-2.9, 15.3)
Virta 2017 (Finland)^	2005–2014	-3.4 (-4.6, -2.2)
Overall Pooled AAPC (I 2 = 95.4%, p < 0.001)		8.4 (6.0, 10.8)
*Children only (I 2 = 88.4%, p < 0.001)		8.1 (5.5, 10.8)
^Adults only (I 2 = 97.9%, p < 0.001)		7.7 (2.6, 12.7)

Figure 1: Trends in the overall incidence of celiac disease

Funding Agencies

Canadian Celiac Association