Medical Research: What is the background for this study? What are the main findings?
Response: Over the last decades there has been increased clinical awareness of coeliac disease (CD) partially because of improvements in the accuracy and availability of diagnostic tests, however, we do not have current estimates of actual celiac disease diagnoses in children and it is important to know whether diagnostic patterns vary socioeconomic group. Funded by CORE/Coeliac UK and conducted at the University of Nottingham, this study analysed 2,063,421 children aged less than 18 years who were registered with general practices (primary care doctors) across the United Kingdom contributing to their routine electronic health records to The Health Improvement Network (THIN) database between 1993 and 2012. The study found 1,247 children were diagnosed with coeliac disease, corresponding to about 1 new case in every 10,000 children each year. Girls consistently had more diagnoses than boys and whilst the incidence of new celiac disease cases among children up to age 2 years remained stable over time, diagnoses in older children almost tripled over the past 20 years. Moreover, the study found a socioeconomic gradient in celiac disease diagnoses, such that children living in less socioeconomically deprived areas were about twice as likely to be diagnosed as those from more deprived areas. This pattern held for boys and girls and for all ages.
Medical Research: What should clinicians and patients take away from your report?
Response: Clinicians should ensure they implement the most recent diagnostic guidelines and procedures to obtain a diagnosis of celiac disease The gap in childhood diagnosis between the most and least socioeconomically deprived children could be due to different risk factors predisposing to celiac disease , however, there is limited evidence for this thus far. Another likely possibility is that ascertainment of disease varies, so awareness campaigns for clinicians and the general population may help to implement strategies for case-finding in all children and reduce this inequality.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Whilst we assessed patterns of diagnosis only, we are now assessing patient interactions with primary care doctors before their diagnosis to determine if the inequality in childhood celiac disease found is related to lack of seeking medical care or to differences in diagnostic investigations and testing by doctors. Future studies should also investigate other possible explanations for this gradient by exploring the association between exposures to different specific risk factors that may alter predisposition to the occurrence of CD between socioeconomic groups.