Objective The aim was to identify whether ethnic differences in coeliac disease autoimmunity (CDA) in children at 6 years of age exist, and when present, to evaluate how these differences may be explained by sociodemographic and environmental factors.
Design This study was embedded within a multi-ethnic population-based prospective cohort study.
Setting and patients 4442 six-year-old children born between 2002 and 2006 were included. Information on ethnicity, environmental and lifestyle characteristics was assessed by questionnaires. Ethnicity was categorised into Western (Dutch, European, Indonesian, American, Oceanian) and non-Western (Turkish, Moroccan, Cape Verdean, Antillean, Surinamese). Serum transglutaminase type 2 antibody (TG2A) levels were measured with fluorescence enzyme immunoassay. Serum IgG levels against cytomegalovirus (CMV) were measured by ELISA.
Main outcome measures TG2A positivity was defined as TG2A ≥7 U/mL, strong TG2A positivity as TG2A ≥10 upper limit normal (70 U/mL).
Results Of 4442 children, 60 (1.4%) children were TG2A positive, of whom 31 were strong positive. 66% of children were Western, 33% non-Western. Western ethnicity, high socioeconomic position and daycare attendance were positively associated with strong TG2A positivity (odds ratio (OR) 6.85 (1.62 to 28.8) p<0.01, OR 3.70 (1.40 to 9.82) p<0.01, OR 3.90 (1.38 to 11.0) p=0.01 resp.), whereas CMV seropositivity was inversely related to strong TG2A positivity (OR 0.32 (0.12 to 0.84) p=0.02). Together, these factors explained up to 47% (−67 to −17; p=0.02) of the ethnic differences in TG2A positivity between Western and non-Western children.
Conclusions Ethnic differences in children with CDA are present in childhood. Socioeconomic position, daycare attendance and CMV seropositivity partly explained these differences, which may serve as targets for prevention strategies for CDA.
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MAEJ and SAB contributed equally.
Contributors MAEJ contributed to the design of the study, background literature research, data collection, analyses, writing of the manuscript and collated comments from other authors. SAB contributed to the design of the study, the background literature research, data collection, data interpretation, writing of the manuscript and collated comments from other authors. DvdH contributed to the design of the study, data collection and immunological data analysis. JCK-dJ contributed to the design of the study, interpretation of the data and writing of the manuscript. HR contributed to the design of the study, interpretation of the data and writing of the manuscript. VWVJ conceptualised and designed the Generation R Study and contributed to the writing of the manuscript. MCvZ contributed to the design of the study, immunological data analyses, data interpretation and writing of the manuscript. HAM obtained funds, designed the study, supervised the project, contributed to data interpretation and writing of the manuscript. All authors have access to all of the data, take responsibility for the integrity of the data, the accuracy of the data analysis and approved the final version of the manuscript. MAEJ, SAB and HAM are guarantors of the study and accept full responsibility for the work and the conduct of the study. All authors confirm that neither this manuscript nor any part of it has been published or is being considered for publication elsewhere.
Funding This phase of the Generation R Study was supported by the Erasmus MC, Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development (ZonMw), and by NutsOhra.
Competing interests None declared.
Patient consent Obtained.
Ethics approval METC.
Provenance and peer review Not commissioned; externally peer reviewed.
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