Celiac Disease Linked to a Small But Significant Mortality Increase

By Jessica Pyhtila, PharmD, BCGP, BCPS

A recent study published in the Journal of the American Medical Association investigated the relationship between celiac disease and overall mortality. Although a link had previously been determined in previous studies, those trials generally predated the increase in diagnosis rates over the past two decades.

The trial was a population-based study in Sweden that evaluated people with a celiac disease diagnosis between 1969 and 2017. Diagnosis was defined as the presence of small intestinal villus atrophy detected on pathology. A total of 49,829 participants were included and subsequently matched with 246,426 controls based on age, sex, county, and year. The primary outcome was mortality from any cause, and the secondary outcome was the specific cause of death.

Baseline data showed that the mean age at diagnosis was 32 years, with 39% younger than age 18. Further, participants were overwhelmingly women, with 62% of diagnoses in females. Most of the participants were diagnosed in the past 20 years, with 64% diagnosed in the year 2000 or later, and 24% diagnosed in the year 2010 or later. Notably, autoimmune disorders were more common at baseline in celiac patients than in the controls. These included type 1 diabetes, rheumatoid arthritis and inflammatory bowel disease.

The study followed participants for a median of 12.5 years. During that time, 13.2% of patients with celiac disease died, a mortality rate of 9.7 deaths per 1000 person-years. This exceeded the mortality rate in the controls, which was 8.6 deaths per 1000 person-years (HR, 1.21 [95% CI, 1.17–1.25]). Researchers noted that mortality risk was greatest in those diagnosed before the age of 40, perhaps because they have a longer timeframe with which to have the disease throughout their lives. When specific causes of death were analyzed, patients with celiac disease were more likely to die from:

-Cardiovascular disease (3.5 vs 3.4 per 1000 person-years; HR, 1.08 [95% CI, 1.02–1.13])

-Cancer (2.7 vs 2.2 per 1000 person-years; HR, 1.29 [95% CI, 1.22–1.36])

-Respiratory disease (0.6 vs 0.5 per 1000 person-years; HR, 1.21 [95% CI, 1.08–1.37])

-Other causes (2.9 vs 2.3 per 1000 person-years; HR, 1.35 [95% CI, 1.28–1.43])

The researchers concluded that patients with celiac disease have a small but significant increase in mortality risk. Although the mechanism by which this occurs is unknown, the researchers postulated that it may be linked to chronic inflammation.

References:

1) Lebwohl, Benjamin; et al. (2020). “Association Between Celiac Disease and Mortality Risk in a Swedish Population.” Retrieved from: https://jamanetwork.com/journals/jama/fullarticle/2764182