Using nationwide data from Sweden’s pathology departments, linked to national healthcare registers, researchers at Karolinska Institutet and Columbia University examined almost 50,000 patients with celiac disease and their risk of death.

Twenty-one percent increased mortality

Compared with controls, overall mortality was increased by 21% in those with celiac disease. The relative increase in mortality risk was present in all age groups and greatest in those diagnosed in the age range of 18 to 39 years old.

Individuals with celiac disease were at increased risk of death from cardiovascular disease, cancer, and respiratory disease. Compared with controls, the overall mortality risk was greatest in the first year after diagnosis but the risk increase persisted beyond 10 years after diagnosis. The increased risk was present also in patients diagnosed during recent years (2010–2017).

Inflammation is bad for health

“Celiac disease is characterized by inflammation, which is generally bad for your health,” says corresponding and last author, Jonas F Ludvigsson, senior paediatrician at Örebro University Hospital and professor of clinical epidemiology at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet. “I am therefore not surprised that we found an increased mortality for a number of causes of death in individuals with celiac disease.”

The fact that the relative risks were highest in the first year of follow-up can have several explanations, says Jonas F Ludvigsson.

“The intestinal inflammation is often most intense around diagnosis, and before a gluten-free diet has had an effect on mucosal healing. Another possible explanation is that the celiac diagnosis may have been made in patients who were very ill from other causes.”

In separate analyses, the authors adjusted for socioeconomic status and comorbidity but the increased mortality risk for people with celiac disease remained.

The research was funded by the Swedish Research Council, the Celiac Disease Foundation and the Louis and Gloria Flanzer Philanthropic Trust. Jonas F Ludvigsson has previously coordinated another study that received funding from the pharmaceutical company Janssen. No other potential conflicts of interest are reported in the paper.