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Risk of Severe Covid-19 in Patients with Celiac Disease: A Population-Based Cohort Study
Benjamin Lebwohl1,2, Emma Larsson3, Jonas Söderling4
1Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
Insights
Individuals with celiac disease (CeD) do not face a higher risk of severe COVID-19 outcomes. This study found no increased risk of hospitalization or critical illness from coronavirus disease 2019 (COVID-19) in CeD patients.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Celiac disease (CeD) patients exhibit increased susceptibility to viral infections and pneumococcal pneumonia.
- Concerns exist regarding potential increased risk of severe coronavirus disease 2019 (COVID-19) in CeD patients.
Purpose of the Study:
- To determine the association between celiac disease and severe COVID-19 outcomes.
- Quantify the risk of COVID-19 hospitalization and severe disease in individuals with CeD.
Main Methods:
- Population-based cohort study in Sweden (1969-2017).
- Identified 40,963 CeD patients and 183,892 matched controls.
- Used Cox proportional hazards models to assess COVID-19 hospitalization and severe disease risk through July 31, 2020.
Main Results:
- Adjusted hazard ratios (HR) for COVID-19 hospitalization in CeD patients were 1.10 (95% CI 0.80-1.50).
- Adjusted HR for severe COVID-19 (ICU admission and/or death) in CeD patients were 0.97 (95% CI 0.59-1.59).
- No significant differences in COVID-19 mortality were observed between CeD patients and controls.
Conclusions:
- Celiac disease is not associated with an increased risk of COVID-19 hospitalization.
- CeD does not elevate the risk of severe COVID-19, including intensive care unit admission or death.
Background:
Patients with celiac disease (CeD) are at increased risk of certain viral infections and of pneumococcal pneumonia, raising concerns that they may be susceptible to severe coronavirus disease 2019 (Covid-19). We aimed to quantify the association between CeD and severe outcomes related to Covid-19.
Methods:
We performed a population-based cohort study, identifying individuals with CeD in Sweden, as defined by small intestinal villus atrophy diagnosed at all (n=28) Swedish pathology departments during the years spanning 1969-2017, and alive on February 1, 2020. We compared these patients to controls matched by sex, age, county, and calendar period. We performed Cox proportional hazards with follow-up through July 31, 2020, assessing risk of 1) hospital admission with a primary diagnosis of laboratory-confirmed Covid-19 (co-primary outcome); and 2) severe disease as defined by admission to intensive care unit and/or death attributed to Covid-19 (co-primary outcome).
Results:
Among patients with CeD (n=40,963) and controls (n=183,892), the risk of hospital admission for Covid-19 was 2.9 and 2.2 per 1000 person-years respectively. After adjusting for comorbidities, the risk of hospitalization for Covid-19 was not significantly increased in patients with CeD (HR 1.10; 95% CI 0.80-1.50), nor was the risk of severe Covid-19 increased (HR 0.97; 95% CI 0.59-1.59). Results were similarly null when we compared CeD patients to their non-CeD siblings with regard to these outcomes. Among all patients with CeD and controls hospitalized with a diagnosis of Covid-19 (n=58 and n=202, respectively), there was no significant difference in mortality (HR for CeD compared to controls 0.96; 95% CI 0.46-2.02).
Conclusion:
In this population-based study, CeD was not associated with an increased risk of hospitalization for Covid-19 or intensive care unit and/or death attributed to Covid-19.
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