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Increased risk of hospital admission for influenza in patients with celiac disease: a nationwide cohort study in Sweden
Örebro University, School of Health and Medical Sciences. Astrid Lindgren Childrens Hosp, Karolinska Univ Hosp, Solna, Sweden.
Örebro University Hospital, Örebro, Sweden.
Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden.ORCID iD: 0000-0003-1024-5602
2010 (English)In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 105, no 11, p. 2465-2473Article in journal (Refereed) Published
Abstract [en]

Objectives: Although earlier studies suggest an increased risk of infectious disease in celiac disease (CD), data on the risk of influenza in patients with CD are limited. We examined the risk of hospital admission for influenza in CD patients, but for comparative reasons also in individuals with small-intestinal inflammation or normal mucosa but positive CD serology.

Methods: In 2006-2008, we collected duodenal/jejunal biopsy data on CD (Marsh 3: villous atrophy, VA; n=29,008 unique individuals) and inflammation (Marsh 1-2; n=13,200) from all 28 pathology departments in Sweden. A third regional cohort consisted of 3,709 individuals with positive CD serology but normal mucosa (Marsh 0). The biopsies were performed between 1969 and 2008. Through linkage with the Swedish Hospital Discharge Register, we estimated the risk of hospital admission for influenza compared with that of 224,114 age-and sex-matched controls from the general population.

Results: Individuals with CD were at increased risk of hospital admission for influenza (hazard ratio (HR)=2.1; 95% confidence interval (CI)=1.6-2.7; n=81). The absolute risk of influenza was 30/100,000 person-years (excess risk: 16/100,000 person-years). Furthermore, children with CD were at increased risk of influenza (HR=2.5; 95% CI=1.3-4.8). Whereas individuals with inflammation without VA were also at increased risk of influenza (HR=1.9; 95% CI=1.4-2.5), individuals with normal mucosa but positive CD serology were not (HR=1.2; 95% CI=0.5-3.0).

Conclusions: This study found an increased risk of hospital admission for influenza in patients with CD.

Place, publisher, year, edition, pages
New York, USA: Nature Publishing Group, 2010. Vol. 105, no 11, p. 2465-2473
National Category
Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-18874DOI: 10.1038/ajg.2010.352ISI: 000283775600019PubMedID: 20823839Scopus ID: 2-s2.0-78149282225OAI: oai:DiVA.org:oru-18874DiVA, id: diva2:445607
Available from: 2011-10-04 Created: 2011-09-30 Last updated: 2018-04-24Bibliographically approved
In thesis
1. Risc factors and associated disorders of celiac disease
Open this publication in new window or tab >>Risc factors and associated disorders of celiac disease
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Celiac disease (CD) is an immune-mediated enteropathy induced by dietary gluten. CD is prevalent in some 1 % of the general population. In recent decades there has been a marked increase in CD prevalence that may be influenced by environmental risk factors.

Aims: The aim of this thesis was to examine possible risk factors for CD and to gain information on associated disorders of CD.

Methods: In study I we used regional cohort-data from ~11,000 children to examine the association between psychological stress in early life and subsequent CD. In studies II-IV we used nationwide histopathology data to identify individuals with CD (i.e. villous atrophy). In study II we linked data on ~29,000 CD patients to the National patient register to examine the risk of hospital admission for influenza. In studies III-IV we linked data on ~11,000 CD patients to several Swedish registries, including the Medical birth register, to examine neonatal risk factors in CD (study III) and the risk of CD in patients with Down syndrome (study IV).

Results: Psychological stress in the first years of life was not associated with subsequent CD. We found a two-fold increased risk of hospital admission for influenza in patients with CD (95 % confidence interval [CI] = 1.6-2.7).While elective cesarean delivery was associated with an increased risk of later CD (adjusted Odds Ratio [OR] = 1.15; 95 % CI = 1.04-1.26), emergency cesarean delivery was not (adjusted OR = 1.02; 95 % CI = 0.92-1.13). Finally, in study IV we found a six-fold increased risk of CD in children with Down syndrome (95 % CI = 5.09-7.43).

Conclusion: This thesis supports the hypothesis that certain environmental risk factors, such as mode of delivery, but possibly not early psychological stress, influence the risk of CD. The increased risk of hospital admission for influenza indicate that individuals with CD may benefit from influenza immunization. The highly increased risk of CD in Down syndrome supports CD screening in Down syndrome patients.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 102
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 68
Keywords
Celiac disease, cohort study, Down syndrome, influenza, pediatrics, population-based, pregnancy outcome, psychological stress, registry
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-22136 (URN)978-91-7668-865-6 (ISBN)
Public defence
2012-05-25, Wilandersalen, Universitetssjukhuset i Örebro, Örebro, 13:30 (Swedish)
Opponent
Supervisors
Available from: 2012-03-16 Created: 2012-03-16 Last updated: 2017-10-17Bibliographically approved

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Mårild, KarlFredlund, HansLudvigsson, Jonas F.

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