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The Relationship Between Child Mortality Rates and Prevalence of Celiac Disease
Federico Biagi1, Alberto Raiteri1, Annalisa Schiepatti1
1First Department of Internal Medicine, Coeliac Centre.
Insights
Global under-5 mortality rates are decreasing, paralleled by an increase in celiac disease (CD) prevalence. Higher mortality rates correlate with lower CD prevalence, suggesting environmental factors influence disease occurrence.
Area of Science:
- Epidemiology
- Public Health
- Pediatrics
Background:
- Celiac disease (CD) prevalence is rising globally.
- Historical CD prognosis was poor before identifying gluten's role.
- Under-5 mortality rates have significantly declined worldwide.
Purpose of the Study:
- To investigate the relationship between children under-5 mortality rates and celiac disease prevalence.
- To analyze trends in CD prevalence in relation to global child mortality.
Main Methods:
- Literature review of 27 studies on celiac disease prevalence in schoolchildren across 17 countries.
- Meta-analysis of prevalence rates from 1995-2011, including 4 Italian studies.
- Comparative analysis of prevalence based on under-5 mortality groups, publication year, and age.
Main Results:
- A significant inverse correlation (Spearman's rho = -0.63) was found between under-5 mortality rates and CD prevalence (P < 0.001).
- Decreasing under-5 mortality rates globally are associated with increasing celiac disease prevalence.
- Meta-analysis of Italian studies confirmed this trend over time.
Conclusions:
- Under-5 mortality rates appear to influence the prevalence of celiac disease.
- Improved environmental conditions contribute to better survival of children with CD.
- An increase in celiac disease patient numbers is anticipated in the future.
Objectives:
Some evidence suggests that prevalence of celiac disease in the general population is increasing over time. Because the prognosis of celiac disease was a dismal one before discovering the role of gluten, our aim was to investigate a possible relationship between children under-5 mortality rates and prevalence rates of celiac disease.
Methods:
Thanks to a literature review, we found 27 studies performed in 17 different countries describing the prevalence of celiac disease in schoolchildren; between 1995 and 2011, 4 studies were performed in Italy. A meta-analysis of prevalence rates was performed. Prevalence was compared between specific country under-5 mortality groups, publication year, and age.
Results:
In the last decades, under-5 mortality rates have been decreasing all over the world. This reduction is paralleled by an increase of the prevalence of celiac disease. The Spearman correlation coefficient was -63%, 95% confidence interval -82% to -33% (P < 0.001). So, the higher the mortality rate, the lower the prevalence of CD. This finding is confirmed by the meta-analysis of the 4 studies conducted in Italy over time.
Conclusions:
The under-5 mortality rate seems to influence the prevalence of celiac disease in the general population. In the near future, the number of patients with celiac disease will increase, thanks to the better environmental conditions that nowadays allow a better survival of children with celiac disease.
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