Lebwohl et al (2020) PDF: Association Between Celiac Disease and Mortality Risk in Swedish Population

Research JAMA | Original Investigation Association Between Celiac Disease and Mortality Risk in a Swedish Population Benjamin Lebwohl, MD, MS; Peter H. R. Green, MD; Jonas Söderling, PhD; Bjorn Roelstraete, PhD; Jonas F. Ludvigsson, MD, PhD Supplemental content IMPORTANCE Celiac disease may be assoc...

Research JAMA | Original Investigation Association Between Celiac Disease and Mortality Risk in a Swedish Population Benjamin Lebwohl, MD, MS; Peter H. R. Green, MD; Jonas Söderling, PhD; Bjorn Roelstraete, PhD; Jonas F. Ludvigsson, MD, PhD Supplemental content IMPORTANCE Celiac disease may be associated with a modest but persistent increased long-term mortality risk. It is uncertain whether this risk has changed in the era of wider diagnosis rates, less severe clinical disease, and more widespread availability of gluten-free food. OBJECTIVE To evaluate the association between celiac disease and mortality risk in a population-based cohort in Sweden. DESIGN, SETTING, AND PARTICIPANTS All individuals in Sweden with celiac disease diagnosed between 1969 and 2017 were identified through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) cohort. Participants (n = 49 829) were observed starting on the day of the biopsy. The final date of follow-up was December 31, 2017. EXPOSURES Celiac disease was defined by the presence of small intestinal villus atrophy on histopathology specimens during the years 1969-2017 from Sweden’s 28 pathology departments. Each individual was matched with as many as 5 control participants in the general population by age, sex, county, and calendar period. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality, and the secondary outcome was cause-specific mortality. Patients with celiac disease were compared with controls using stratified Cox proportional modeling, stratifying by year of diagnosis. RESULTS There were 49 829 patients with celiac disease, including 24% who were diagnosed between the years 2010 and 2017. The mean (SD) age at diagnosis was 32.2 (25.2) years and 62.4% were women. During a median follow-up time of 12.5 years, 13.2% (n = 6596) died. Compared with controls (n = 246 426), overall mortality was increased in those with celiac disease (9.7 vs 8.6 deaths per 1000 person-years; absolute difference, 1.2 per 1000 person-years; hazard ratio [HR], 1.21 [95% CI, 1.17-1.25]). The relative increase in mortality risk was present in all age groups and was greatest in those diagnosed in the age range of 18 to 39 years (1.9 vs 1.1 per 1000 person-years; HR, 1.69 [95% CI, 1.47-1.94]; P values for heterogeneity comparing 18-39 years with 40-59 years and with 60 years were both