Morbidity and mortality among older individuals with undiagnosed celiac disease

Abstract

Background & aims: Outcomes of undiagnosed celiac disease (CD) are unclear. We evaluated the morbidity and mortality of undiagnosed CD in a population-based sample of individuals 50 years of age and older.

Methods: Stored sera from a population-based sample of 16,886 Olmsted County, Minnesota, residents 50 years of age and older were tested for CD based on analysis of tissue transglutaminase and endomysial antibodies. A nested case-control study compared serologically defined subjects with CD with age- and sex-matched, seronegative controls. Medical records were reviewed for comorbid conditions.

Results: We identified 129 (0.8%) subjects with undiagnosed CD in a cohort of 16,847 older adults. A total of 127 undiagnosed cases (49% men; median age, 63.0 y) and 254 matched controls were included in a systematic evaluation for more than 100 potentially coexisting conditions. Subjects with undiagnosed CD had increased rates of osteoporosis and hypothyroidism, as well as lower body mass index and levels of cholesterol and ferritin. Overall survival was not associated with CD status. During a median follow-up period of 10.3 years after serum samples were collected, 20 cases but no controls were diagnosed with CD (15.2% Kaplan-Meier estimate at 10 years).

Conclusions: With the exception of reduced bone health, older adults with undiagnosed CD had limited comorbidity and no increase in mortality compared with controls. Some subjects were diagnosed with CD within a decade of serum collection, indicating that although most cases of undiagnosed CD are clinically silent, some result in symptoms. Undiagnosed CD can confer benefits and liabilities to older individuals.

Figure 1. Impact of undiagnosed celiac disease on lumbar spine T-score

Serology negative n=82, Serology positive n=51 Age, serology negative vs. serology positive = 62.2 vs. 63.7 (p=0.22) Female gender, serology negative vs. serology positive = 85.4% vs. 82.4% (p=0.64)

Figure 2

Summary of outcomes of undiagnosed celiac disease cases compared to serology-negative controls ^†Odds Ratio (95% CI) from conditional logistic regression which retains the matching