Aragon Institute of Health Sciences IACS, Zaragoza, Spain.
Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain.
BMC Health Serv Res. 2019 Aug 16;19(1):578. doi: 10.1186/s12913-019-4407-4.
Celiac disease (CD) is an autoimmune chronic enteropathy of the small intestine caused by exposure to gluten in genetically predisposed individuals. CD is not easy to diagnose due to its unspecific symptomatology, especially in adults, a diagnosed/undiagnosed ratio of 1:7 is estimated. CD does not have its own code in the International Classification of Primary Care (ICPC) but it is coded under code D99 "Disease digestive system, other", which hinders diagnosis, intervention and research. The aim of this study is to investigate the prevalence of CD in Aragón, Spain, using the information available from Primary Care, as well as to discuss the difficulties involved in determining prevalence of CD from data collected at this level of medical intervention.
We designed an epidemiological cross-sectional study and analysed 26,964 electronic clinical records from the Aragonese Health Service under code ICPC D99 collected up to December 31st, 2016. The clinical records were classified by their editable field "descriptor" according to their probability of being related to CD. Analyses of gender, age, age at diagnosis, province and health sector were carried out.
We found 4534 clinical records under 293 different descriptors with a high probability of referring to CD. Prevalence in Aragón was estimated to be 0.35% ranging from 0.24 to 0.81% with important differences among health sectors.
The prevalence of 0.35% is a long way from the generally accepted 1% but within the usually considered ratio 1:7 of diagnosed:undiagnosed cases. Differences among sectors should be carefully analysed. Lacking its own ICPC code, diagnosis of CD in Primary Care Services is not included in a single category, but it is distributed under several descriptors, which makes it difficult to offer any firm diagnosis for treatment and hinders research. Finally, the high prevalence of CD justifies its own ICPC code and the need to withdraw CD from the generic D99 code "Disease digestive system other".
乳糜泻（CD）是一种由遗传易感性个体接触麸质引起的自身免疫性慢性小肠疾病。由于其非特异性症状，CD 不易诊断，尤其是在成年人中，估计诊断/未诊断比例为 1:7。CD 在初级保健国际分类（ICPC）中没有自己的代码，但它被编码为 D99“消化系统其他疾病”，这阻碍了诊断、干预和研究。本研究旨在通过初级保健提供的信息调查西班牙阿拉贡的 CD 患病率，并讨论从这一级医疗干预收集的数据确定 CD 患病率所涉及的困难。
我们设计了一项横断面流行病学研究，分析了截至 2016 年 12 月 31 日收集的阿拉贡卫生服务机构中以 ICPC D99 代码编码的 26964 份电子临床记录。临床记录根据其可编辑字段“描述符”按照与 CD 相关的概率进行分类。对性别、年龄、诊断年龄、省份和卫生部门进行了分析。
我们在 293 个不同描述符下发现了 4534 份临床记录，这些描述符具有高度的 CD 相关性。阿拉贡的患病率估计为 0.35%，范围为 0.24%至 0.81%，不同卫生部门之间存在显著差异。
0.35%的患病率与普遍接受的 1%相差甚远，但在通常认为的 1:7 的诊断病例：未诊断病例比例范围内。各部门之间的差异应仔细分析。由于缺乏自己的 ICPC 代码，初级保健服务中 CD 的诊断未归入单一类别，而是分布在几个描述符下，这使得难以提供任何明确的诊断进行治疗，并阻碍了研究。最后，CD 的高患病率证明其需要自己的 ICPC 代码，并需要将 CD 从通用 D99 代码“消化系统其他疾病”中删除。
