The Global Epidemiology of Celiac Disease: How Often is Celiac Disease Being Diagnosed, and Has This Changed Over Time?
Date
2019-09-18
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Celiac disease (CD) is an autoimmune disorder wherein the small intestine becomes damaged upon consuming dietary gluten. Approximately 0.5% to 1.0% of the population in the world have CD, although underdiagnosis remains common in many areas. Further, incidence appears to be rising in several countries, but this has not been systematically assessed. Therefore, the aim of this thesis is to determine the global incidence of CD, and how this has changed over time. A systematic review was conducted to identify all population-based studies reporting on CD incidence. Temporal analyses were performed to estimate the average annual percent change in CD incidence over time. Choropleth maps and scatter plots were generated to highlight regional differences in CD incidence. Incidence rates in the 21st-century were pooled, using meta-analyses, to estimate sex- and age-specific incidence. Studies evaluating incidence patterns of CD come from highly industrialized nations in Europe, North America, and Oceania. Of studies with sufficient data for temporal analyses, 73.3% showed a significant increase in CD incidence over time, with a few studies finding stable incidence in more recent years. In the 21st-century, females were diagnosed approximately twice as often as males, and children were diagnosed almost twice as often as adults, although there is geographic variation in these patterns. There are several potential explanations for the trends observed: An improved ability to detect and diagnose CD has identified many prevalent cases that would have otherwise gone undiagnosed; but there is also evidence to suggest a genuine increase in the disease occurrence beyond diagnostic improvements. This thesis aimed to assess the global incidence of CD; however, there are notable literature gaps with no population-based studies in Latin America, Africa, or Asia. With more patients being diagnosed in industrialized parts of the world, many burdens associated with CD will increase—healthcare systems need to prepare for an increased prevalence and the shift in disease management that is expected as novel therapies soon become established. An interactive web-based map (https://people.ucalgary.ca/~ggkaplan/celiac.html) with incidence estimates and temporal shifts provide an excellent resource for stakeholders to utilize for healthcare planning and guide future research.
Description
Keywords
celiac disease, systematic review, meta-analysis, incidence, trends
Citation
King, J. A. (2019). The Global Epidemiology of Celiac Disease: How Often is Celiac Disease Being Diagnosed, and Has This Changed Over Time? (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.