Table 5

Previous literature on the association between socioeconomic status and coeliac disease

Geographic areaStudy populationSource of the outcome
N=number of cases
Source of socioeconomic statusMain findings
Diagnosed CD (serology and/or biopsy-positive cases) within medical settings
Burger et al12NetherlandsSubjects identified into the Dutch Pathology Registry, which covers all pathology labs in Netherlands 1995–2010
N= 6444
CD diagnosis according to biopsy reports
The socioeconomic status scores based on income, level of education and employmentPatients diagnosed with CD during childhood were more often from an area with a higher socioeconomic status compared with patients diagnosed later in life (p<0.001)
West et al13The UKAll ages UK population registered with the Clinical Practice Research Datalink—1990–2011
N=65 856 848 person-years
People with Read codes representing CD (J690.00; J690.13; J690z00; J690100; J690.14; J690000)
Indices of Multiple DeprivationThe CD incidence was 27% lower in people from the most-deprived areas than in people from the least-deprived ones (IRR 0.83, 95% CI 0.77 to 0.89)
Whyte et al14Cardiff, Newport and Powys (South Wales)The total paediatric population (age <16) in South Wales (UK national census 2008)
N=298 530 children
CD diagnosis according to ESPGHAN 1990 criteria in the same tertiary medical centre between 1995 and 2012
Welsh Index of Multiple DeprivationThe prevalence of CD in the lowest deprivation level was 1.16/1000 and 0.49/1000 in the highest deprivation level
White et al15Southeast ScotlandThe total paediatric population (age <16) in Southeast Scotland—1990–2009 (Scotland census)
N=∼225 000 children
CD diagnosis according to ESPGHAN 1990 criteria. Data from hospital records (ICD codes of CD), paediatric pathology records, regional clinical database, regional serology database and the electronic hospital record
The Scottish government data for the Standard Index of Multiple Deprivation and urban/rural indicesThe median of the Standard Index of Multiple Deprivation score and urban–rural classification indices of patients with CD were comparable to the general population of southeastern Scotland
Olén et al16SwedenIndividuals aged 16–64 years using the Total Population Register
N=174 186 subjects
CD diagnosis according to biopsy reports collected from all Swedish pathology departments
N=29 096
European Socioeconomic Classification based on occupation.
Data collected using The Swedish Occupational Register
Individuals from the lowest social class were 11% less likely to be diagnosed with CD (OR 0.89, 95% CI 0.84 to 0.94)
Wingren et al17SwedenProspective evaluation of babies born in Sweden between 1987 and 1993 (follow-up 2 years)
N=392 568 men and 372 112 women
The Swedish National Hospital Discharge Registry according to ICD codes of CD
N=845 in men and 1401 in women
Information on the mothers’ pre-tax equalised household income and social allowance for the year before delivery (five classes)Boys born to mothers in an overt low socioeconomic position had a higher risk of CD (OR 1.37, 95% CI 1.03 to 1.82) than those with mothers with high income and no social allowance
Robert et al18South East EnglandBabies born in the south east of England between 1970 and 1999 (mean follow-up duration 18 years) using the Oxford record linkage study database having linked maternity data in the same dataset
N=248 521
Children with both a maternity record and a subsequent admission for CD (ICD codes of CD) in the Oxford record linkage study database
Information collected from maternal records in the Oxford record linkage study databaseChildren from manual social classes IV and V had a 4.02 increased risk of coeliac disease (95% CI1.96 to 8.25) compared with those from professional social classes I and II
Ludvigsson19SwedenBabies born in southeast Sweden between 1997 and 1999 (follow-up 15 years)
N=15 875 single births
Coeliac cases reported by eight paediatric departments
A case was included if he had intestinal biopsy suggesting CD, no symptoms after the introduction of a gluten-free diet and/or no or only minor histopathological abnormalities consistent with CD at the control biopsy under treatment with gluten-free diet
Information collected in questionnaire completed by the mothers shortly after childbirth on: place of living 1 year before conception, maternal employed during pregnancy, paternal employed the year before the conception, family crowed livingCD was less common in mothers who had worked <3 months during pregnancy (OR=0.29; 95% CI 0.09 to 0.94; p=0.039). The other socioeconomic factors were not associated
Screening detected CD in the general population
Kondrashova et al20Finland and RussiaSchoolchildren
Russia Karelia: age ranged 6.2–18.3 years (1997–2001)
N=1988 children
Northern Finland: age ranged 7–18 years (1994)
N= 3654 children
Serological screening by tTGA
All subjects who were positive were offered an intestinal biopsy to confirm CD diagnosis.
N=4 in Russia and 34 in Finland
Comparison between two areas with opposite socioeconomic condition (poor Russia vs rich Finland).0.6% of the children (12/1988; CI 0.3% to 1.1%) in Russian Karelia tested positive for tTGA compared with 1.4% (52/3654; CI 1.1% to 1.9%) in the Finnish cohort. Biopsy-proven CD: N=4 in Russia and 34 in Finland (no biopsy in 13 subjects)
West et al21CambridgeParticipants, age 45–76 years registered with a general practice in Cambridge, England (1990–1995)
Serological screening by EMA
Participant-reported occupation categorised as professional, skilled, unskilled/partly skilledEMA positivity less common in partly skilled or unskilled workers, as compared to professionals (OR 0.51, 95% CI 0.18 to 1.43)
  • CD, coeliac disease; EMA, antiendomisial antibody; ESPGHAN, European Society of Paediatric Gastroenterology, Hepatology and Nutrition; ICD, international classification of disease; IRR, incident rate ratio; tTGA, IgA antitransglutaminase.