Esophagus to Small Intestine

Gastroenterology. 2023;164(4):567−78.e7

King JA, Bakal JA, Li B, Whitten TA, Gidrewicz D, Turner JM, Veldhuyzen van Zanten S, Huynh HQ, Heitman SJ, Aziz Shaheen A, Quan H, Godley J, Underwood FE, Hracs L, Bergman D, Ludvigsson JF, Lebwohl B, Benchimol EI, Williamson T, Kaplan GG

Variation in testing for and incidence of celiac autoimmunity in Canada: A population-based study

Background and aims: The incidence of biopsy-confirmed celiac disease has increased. However, few studies have explored the incidence of celiac autoimmunity based on positive serology results.
Methods: A population-based cohort study assessed testing of tissue transglutaminase antibodies (tTG-IgA) in Alberta from 2012 to 2020. After excluding prevalent cases, incident celiac autoimmunity was defined as the first positive tTG-IgA result between 2015 and 2020. Testing and incidence rates for celiac autoimmunity were calculated per 1000 and 100,000 person-years, respectively. Incidence rate ratios (IRRs) were calcu-lated to identify differences by demographic and regional factors. Average annual percent changes (AAPCs) assessed trends over time.
Results: The testing rate of tTG-IgA was 20.2 per 1000 person-years and remained stable from 2012 to 2020 (AAPC, 1.2%; 95% confidence in-terval [CI]: -0.5–2.9). Testing was higher in female patients (IRR = 1.66; 95% CI: 1.65−1.66), those living in metropolitan areas (IRR = 1.39; 95% CI: 1.38−1.40), and in areas of lower socioeconomic deprivation (lowest compared to highest IRR = 1.24; 95% CI: 1.23−1.25). Incidence of celiac autoimmunity was 33.8 per 100,000 person-years and increased from 2015 to 2020 (AAPC, 6.2%; 95% CI: 3.1−9.5). Among those with tTG-IgA results ≥ 10 times the upper limit of normal, the incidence was 12.9 per 100,000 person-years. The incidence of celiac autoimmunity was higher in metropolitan settings (IRR = 1.28; 95% CI: 1.21−1.35) and in the least socioeconomically deprived areas compared to the highest (IRR = 1.22; 95% CI: 1.14−1.32).

Conclusions: Incidence of celiac autoimmunity is high and increasing, despite stable testing rates. Variation in testing patterns may lead to un-der-reporting the incidence of celiac autoimmunity in non-metropolitan areas and more socioeconomically deprived neighborhoods.

Prof. Dr. G.G. Kaplan, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, O’Brien Institute for Public Health and Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada,

DOI: 10.1053/j.gastro.2022.12.040

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