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[Assessment of an algorithm to identify paediatric-onset celiac disease cases through administrative healthcare
Gisella Pitter1, Roberto Gnavi2, Pierantonio Romor3
1Dipartimento di scienze cardiologiche, toraciche e vascolari, Università degli studi di Padova.
Insights
Administrative healthcare databases can identify pediatric celiac disease cases. Pathology reports are crucial, with combinations of databases improving case ascertainment for celiac disease diagnosis.
Area of Science:
- Epidemiology
- Public Health
- Pediatric Gastroenterology
Background:
- Accurate identification of pediatric celiac disease cases is essential for timely diagnosis and management.
- Administrative healthcare databases offer a potential resource for epidemiological studies but their utility for identifying specific conditions like celiac disease requires evaluation.
Purpose of the Study:
- To assess the role and effectiveness of four administrative healthcare databases in identifying possible pediatric celiac disease cases.
- To evaluate the consistency and overlap between different data sources for celiac disease case ascertainment.
Main Methods:
- A population-based observational study using record linkage of administrative healthcare databases.
- Inclusion of children born in the Friuli Venezia Giulia Region (Northern Italy) between 1989-2012.
- Definition of possible celiac disease based on pathology reports of intestinal villous atrophy, copayment exemptions, hospital discharge records (ICD-9-CM codes), and gluten-free food prescriptions.
Main Results:
- Out of 962 possible pediatric celiac disease cases, individual databases identified between 66.1% and 74.2%.
- The four sources coexisted in 42.2% of cases, with 27.6% identified by a single source, notably 16.9% by pathology reports alone.
- Combining copayment exemptions and discharge records identified 80.5% of cases; adding gluten-free food prescriptions increased this to 83.1%.
Conclusions:
- The four administrative healthcare databases show partial consistency in identifying pediatric celiac disease.
- Pathology reports are a significant, and sometimes exclusive, source for identifying possible pediatric celiac disease cases.
- Combinations of databases, particularly exemptions and discharge records, enhance case ascertainment, though pathology reports remain critical for a proportion of cases.
Objectives:
to assess the role of four administrative healthcare databases (pathology reports, copayment exemptions, hospital discharge records, gluten-free food prescriptions) for the identification of possible paediatric cases of celiac disease.
Design:
population-based observational study with record linkage of administrative healthcare databases. SETTING AND PARTICIPANT S: children born alive in the Friuli Venezia Giulia Region (Northern Italy) to resident mothers in the years 1989-2012, identified using the regional Medical Birth Register.
Main Outcome Measures:
we defined possible celiac disease as having at least one of the following, from 2002 onward: 1. a pathology report of intestinal villous atrophy; 2. a copayment exemption for celiac disease; 3. a hospital discharge record with ICD-9-CM code of celiac disease; 4. a gluten-free food prescription. We evaluated the proportion of subjects identified by each archive and by combinations of archives, and examined the temporal relationship of the different sources in cases identified by more than one source. RESULT S: out of 962 possible cases of celiac disease, 660 (68.6%) had a pathology report, 714 (74.2%) a copayment exemption, 667 (69.3%) a hospital discharge record, and 636 (66.1%) a gluten-free food prescription. The four sources coexisted in 42.2% of subjects, whereas 30.2% were identified by two or three sources and 27.6% by a single source (16.9% by pathology reports, 4.2% by hospital discharge records, 3.9% by copayment exemptions, and 2.6% by gluten-free food prescriptions). Excluding pathology reports, 70.6% of cases were identified by at least two sources. A definition based on copayment exemptions and discharge records traced 80.5% of the 962 possible cases of celiac disease; whereas a definition based on copayment exemptions, discharge records, and gluten-free food prescriptions traced 83.1% of those cases. The temporal relationship of the different sources was compatible with the typical diagnostic pathway of subjects with celiac disease.
Conclusions:
the four sources were only partially consistent. A relevant proportion of all possible cases of paediatric celiac disease were identified exclusively by pathology reports.
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