Via Alimentary Pharmacology and Therapeutics 2011; 34: 1012-1019
Summary: Studies of mortality in undetected celiac disease compared with the general population give contradictory findings, suggesting it is either increased fourfold compared with the general population or not at all. Aim To establish all-cause and cause-specific mortality in undiagnosed celiac disease, identified by anti-endomysial antibody (EMA) positivity, in the Cambridge GP Health Survey cohort.
Method: The study group was recruited in 1990 from the general population aged 45-76 years. All deaths were ascertained from the Office for National Statistics. Mortality rates were calculated per 1000 person years and adjusted for age, gender, smoking and socioeconomic group using multivariate Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI).
Results: There were 117,914 patient years of follow-up (median 16.8 years) from 7,527 participants. Eighty-seven had undetected celiac disease, their all-cause mortality rate was 9.4 per 1000 person years (95% CI 5.4-16.1) compared with 12.7 (95% CI 12.1-13.4) in EMA-negative participants.
The adjusted all-cause mortality HR was 0.98 (95% CI 0.57-1.69). Death due to cancer and circulatory diseases was not increased, adjusted HR were 1.27 (95% CI 0.57-2.85) and 1.39 (95% CI 0.66-2.92) respectively.
Conclusions: We observed no excess overall mortality in people aged over 45 years with undetected celiac disease compared with the general population, nor any increase in deaths related to circulatory disease or cancer. Our findings do not support screening the general population aged over 45 years, for celiac disease for the purpose of improving life expectancy.