Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Internal Medicine, Central Finland Central Hospital, Jyväskylä, Finland.
Am J Gastroenterol. 2020 Jul;115(7):1117-1124. doi: 10.14309/ajg.0000000000000665.
We assessed whether celiac disease-associated mortality is increased in Finland among patients diagnosed in the 21st century, given recent improvements in diagnostic and treatment facilities.
Biopsy-proven patients with celiac disease (Marsh III) and dermatitis herpetiformis aged 20-79 years (median 50 years) diagnosed 2005-2014 (n = 12,803) were identified from the national dietary grant registry. Dates and causes of death were obtained from Statistics Finland. Overall mortality and causes of death were compared with reference individuals (n = 38,384) matched for age, sex, and area of residence (at the time of celiac disease diagnosis) selected from the Population Information System.
During a mean follow-up of 7.7 years (SD ±3.0 years), 884 (6.9%) and 2,613 (6.8%) deaths occurred among the celiac cohort and reference group, respectively. Overall mortality (hazard ratio [HR] 1.01, 95% confidence intervals [CIs] 0.94-1.09), mortality from all malignancies (HR 1.11, 95% CI 0.96-1.27), gastrointestinal tract malignancies (HR 1.21, 95% CI 0.56-1.71), or cardiovascular diseases (HR 0.91, 95% CI 0.77-1.07) were not increased among patients with celiac disease. Overall, mortality from lymphoproliferative diseases (HR 2.36, 95% CI 1.65-3.39) and nonmalignant digestive diseases (HR 2.19, 95% CI 1.40-3.43) was increased, but HRs decreased after the exclusion of the first 2 years of follow-up (HR 1.71, 95% CI 1.10-2.66 and HR 1.75, 95% CI 1.01-3.05, respectively).
The overall mortality in adult celiac disease diagnosed 2005-2014 was not increased. Mortality from lymphoproliferative diseases was increased but lower than previously reported.
鉴于近年来诊断和治疗设施的改善，我们评估了在芬兰，21 世纪确诊的乳糜泻患者的死亡率是否会增加。
从国家膳食拨款登记处确定了 2005-2014 年（中位年龄 50 岁）确诊为乳糜泻（Marsh III）和疱疹样皮炎的 20-79 岁（中位年龄 50 岁）活检证实的乳糜泻患者（n=12803）。从芬兰统计局获得死亡日期和死因。将总体死亡率和死因与从人口信息系统中选择的年龄、性别和居住地（在乳糜泻诊断时）相匹配的参考个体（n=38384）进行比较。
在平均 7.7 年（SD±3.0 年）的随访期间，乳糜泻队列和参考组分别发生 884 例（6.9%）和 2613 例（6.8%）死亡。总体死亡率（危险比[HR]1.01，95%置信区间[CI]0.94-1.09）、所有恶性肿瘤（HR 1.11，95%CI 0.96-1.27）、胃肠道恶性肿瘤（HR 1.21，95%CI 0.56-1.71）或心血管疾病（HR 0.91，95%CI 0.77-1.07）的死亡率在乳糜泻患者中并未增加。总体而言，淋巴增生性疾病（HR 2.36，95%CI 1.65-3.39）和非恶性消化疾病（HR 2.19，95%CI 1.40-3.43）的死亡率增加，但排除随访前 2 年后 HR 下降（HR 1.71，95%CI 1.10-2.66 和 HR 1.75，95%CI 1.01-3.05）。
2005-2014 年确诊的成人乳糜泻的总体死亡率没有增加。淋巴增生性疾病的死亡率增加，但低于先前的报告。
