Background: Celiac disease develops in genetically predisposed individuals, influenced by environmental factors. This study assessed the association between early-life antibiotic exposure and celiac disease autoimmunity (CDA).
Methods: This retrospective cohort study used data from Clalit Health Services, the largest Israeli Health Maintenance Organization, on children born between 1995 and 2022. Antibiotic exposure was assessed by type, timing and prescription count during the first year of life. CDA was defined by 2 positive serology tests, and adjusted hazard ratios (HR) were calculated using Cox models, accounting for sex, ethnicity and socioeconomic position (SEP).
Results: A total of 1,860,533 patient records were analyzed, with 8546 (0.5%) diagnosed with CDA [median (interquartile range): age 6.9 (4.4,10.8)]. Antibiotic exposure during the first year of life was observed in 56% of the cohort, with higher rates among males, low SEP and Arab ethnicity. Adjusted HRs for CDA were 1.090 (95% confidence interval: 1.041-1.141, P < 0.001) for the exposure to antibiotics during the first year of life, and 0.893 (95% confidence interval: 0.869-0.918, P < 0.001) for the age of first exposure. A dose-response relationship was observed as prescription numbers increased (HR = 1.076, P = 0.003 for 1-3 prescriptions, HR = 1.426, P < 0.001 for ≥10 prescriptions). Stronger associations between exposure indices to antibiotics and CDA were observed in females and low SEP.
Conclusions: Antibiotic exposure during the first year of life is associated with a higher risk of developing CDA, particularly with increasing prescription numbers, and mainly in females.
Keywords: antibiotic exposure; celiac disease autoimmunity; risk factors.
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