Better diagnosis or other factors?

According to a study published in the Archives of Disease in Childhood, the number of young children diagnosed with coeliac disease in the UK has almost tripled over the past 20 years.

According to this study, a total of 2,063,421 children (from birth to age 18) were registered with general practices across the UK between 1993 and 2012. This information came via data contained in The Health Improvement Network (THIN), a representative UK database of anonymised primary care health records.

The evidence to date suggests that up to 1% of all children in the UK have blood markers for coeliac disease, an autoimmune reaction to dietary gluten from wheat, barley, and rye.  1% of 2,063,421 is 20,634 so this implies that 20,634 children in the UK may have blood markers for coeliac disease.

Among the 2,063,421 children, 1247 had been diagnosed with coeliac disease during this period, corresponding to around 1 new case in every 10,000 children every year. This is at odds with the estimated 1% blood marker estimate and implies that many children may be having dietary reactions to gluten but are being misdiagnosed or are perhaps having symptoms that do not obviously present as dietary.

The diagnosis rate was similar across all four UK countries, and was 53% higher among girls than among boys. Between 1993 and 2012, diagnoses rose by 39% in boys, but doubled in girls.

While the numbers of new cases diagnosed in infants and toddlers remained fairly stable across all four countries, diagnoses among children older than 2 years almost tripled in the space of 20 years.The diagnosis rate for coeliac disease in 2008-12 among children was 75% higher than it was in 1993-97.

Kids from poorer families only half as likely to be diagnosed with the condition

When the researchers analysed the social and economic backgrounds of children diagnosed with the condition, they found that those from less well-off backgrounds were only half as likely to be diagnosed with the condition. This pattern was evident for both boys and girls, and across all ages.

The researchers say the rise in new cases among children is likely to be the result of better awareness of coeliac disease, as well as the means to diagnose it. But this does not explain the differences in diagnoses among children from different socioeconomic backgrounds, they say.

“Based on the current evidence, the most plausible explanation for the socioeconomic gradient in the incidence of childhood coeliac disease whereby children from least deprived areas have [it] diagnosed more often than those from the most deprived areas is that ascertainment of disease varies, rather than the true occurrence of [coeliac disease],” they write.

For more information:

Study Title: Socioeconomic variation in the incidence of childhood coeliac disease in the UK Online First  doi 10.1136/archdischild-2014-307105 Archives of Disease in Childhood is one of more than  50 specialist journals published by BMJ. The title is co-owned with the Royal College of Paediatrics and Child Health.