Socioeconomic variation in the incidence of childhood coeliac disease in the UK
- Fabiana Zingone1,2,
- Joe West1,
- Colin J Crooks1,
- Kate M Fleming1,
- Timothy R Card1,
- Carolina Ciacci2,
- Laila J Tata1
- 1Division of Epidemiology and Public Health, City Hospital Campus, University of Nottingham, Nottingham, UK
- 2Department of Medicine and Surgery, University of Salerno, Salerno, Italy
- Correspondence to Dr Fabiana Zingone, Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, Clinical Sciences Building Phase 2, Hucknall Road, Nottingham NG5 1PB, UK;
- Received 3 July 2014
- Revised 17 November 2014
- Accepted 21 November 2014
- Published Online First 22 January 2015
Background Serological studies indicate that evidence of coeliac disease (CD) exists in about 1% of all children, but we lack estimates of current diagnostic patterns among children and how they vary by socioeconomic group.
Methods We identified all children aged 0–18 years between 1993 and 2012 who were registered with general practices across the UK that contribute to a large population-based general practice database. The incidence of CD was evaluated in each quintile of the Townsend index of deprivation and stratified by age, sex, country and calendar year.
Results Among 2 063 421 children, we identified 1247 CD diagnoses, corresponding to an overall CD incidence of 11.9 per 100 000 person-years, which was similar across the UK countries and higher in girls than in boys. We found a gradient of CD diagnosis across socioeconomic groups, with the rate of diagnosis being 80% higher in children from the least-deprived areas than in those from the most-deprived areas (incident rate ratio 1.80, 95% CI 1.45 to 2.22). This pattern held for both boys and girls and across all ages. Across all four countries of the UK, we found similar associations between CD and socioeconomic status. While CD incidence up to age 2 remained stable over the study period, diagnoses at older ages have almost tripled over the past 20 years.
Conclusions Children living in less socioeconomically deprived areas in the UK are more likely to be diagnosed with CD. Increased implementation of diagnostic guidelines could result in better case identification in more-deprived areas.
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