地中海地区的乳糜泻负担。
Burden of celiac disease in the Mediterranean area.
机构信息
European Laboratory for Food Induced Diseases, Federico II University of Naples, 80131 Naples, Italy.
出版信息
World J Gastroenterol. 2011 Dec 7;17(45):4971-8. doi: 10.3748/wjg.v17.i45.4971.
AIM
To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost.
METHODS
For statistics regarding the population of each country in the Mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available confidence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic profiles amongst Mediterranean countries.
RESULTS
In the next 10 years, the Mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550,000 symptomatic adults and about 240,000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about €4 billion (€387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortality: about 600,000 celiac patients will die in the next 10 years, with an excess of 44.4% vs age- and sex-matched controls.
CONCLUSION
In the near future, the burden of CD will increase tremendously. Few Mediterranean countries are able to face this expanding epidemic alone.
目的
根据发病率、死亡率和卫生费用来评估地中海地区未确诊的乳糜泻（CD）的负担。
方法
为了获取地中海地区每个国家的人口统计数据，我们查阅了权威的国际来源（世界银行、世界卫生组织和联合国）。我们从已发表的报告中获得了大多数国家的 CD 患病率。最后，我们估计该地区的疾病发病率为 1%的病例/总人口，因为报告中报告的发病率的置信区间均未显著排除该比率。从同一队列中的可靠报告中获得了症状和并发症的分布情况。从最近的报告中获得了 1.8 的标准化死亡率。为成人和儿童从出现症状到诊断的年份估算了未加权的卫生费用，并根据购买力平价进行了标准化，以说明地中海国家之间不同的经济状况。
结果
在未来 10 年内，地中海地区将拥有约 5 亿居民，其中 1.2 亿为儿童。预计 2020 年 CD 诊断病例数为 500 万例（100 万例乳糜泻儿童），与 2010 年相比增加了 11%。根据 2010 年的比率，将有大约 55 万症状性成年人和大约 24 万患病儿童：85%的症状性患者将患有胃肠道投诉，40%可能患有贫血，30%可能患有骨质减少，20%的儿童将身材矮小，10%的儿童将出现异常的肝功能酶。在未来 10 年内，预计从症状发作到诊断之间的延迟（成人平均 6 年，儿童 2 年），症状性乳糜泻患者的标准化医疗费用约为 40 亿欧元（儿童为 3.87 亿欧元）。诊断延迟预计会增加死亡率：在未来 10 年内，约有 60 万乳糜泻患者死亡，与年龄和性别匹配的对照组相比，死亡率增加了 44.4%。
结论
在不久的将来，CD 的负担将大大增加。很少有地中海国家能够独自应对这种不断扩大的流行。
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