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Trends and Racial/Ethnic Disparities in Gluten-Sensitive Problems in the United States: Findings from the National Health and Nutrition Examination Surveys From 1988 to 2012

Choung, Rok Seon MD, PhD1; Ditah, Ivo C MD, MPhil1; Nadeau, Ashley M1; Rubio-Tapia, Alberto MD1; Marietta, Eric V MD1; Brantner, Tricia L1; Camilleri, Michael J MD2; Rajkumar, Vincent S MD3; Landgren, Ola MD, PhD4; Everhart, James E MD, MPH5; Murray, Joseph A MD1

American Journal of Gastroenterology: March 2015 - Volume 110 - Issue 3 - p 455–461
doi: 10.1038/ajg.2015.8

Objectives: Racial disparities in the prevalence of celiac disease (CD) and the number of people without CD avoiding gluten (PWAG) in the United States are unknown. We aimed to describe racial differences in the prevalence of CD and PWAG, and evaluate the trends of CD in the noninstitutionalized civilian adult population of the US between 1988 and 2012.

Methods: A population-based cross-sectional study was conducted using data from the National Health and Nutrition Examination Surveys (NHANES) from 1988 to 1994, 1999 to 2004, and 2009 to 2012. Serum samples from the NHANES participants were tested for CD serology, which included IgA tissue transglutaminase (tTG IgA) and, if findings were abnormal, for IgA endomysial antibodies. Information about adherence to a gluten-free diet was obtained by means of an interviewer-administered questionnaire.

Results: In NHANES 2009–2012, the adjusted prevalence of CD was significantly higher (P<0.0001) among non-Hispanic whites (1.0%) than among non-Hispanic blacks (0.2%) and Hispanics (0.3%), whereas the adjusted prevalence of PWAG was significantly higher (P=0.01) in blacks (1.2%) as compared with Hispanics (0.5%) and whites (0.7%). The seroprevalence of CD in adults aged 50 years and older increased from 0.17% (95% confidence interval (CI) 0.03–0.33) in 1988–1994 to 0.44% (95% CI 0.24–0.81) in 2009–2012 (P<0.05).

Conclusions: The overall prevalence of CD increased between 1988 and 2012 and is significantly more common in whites. In addition, a higher proportion of individuals maintaining a gluten-free diet in the absence of a diagnosis of CD are blacks.

1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

2Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA

3Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA

4Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

5Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA

Correspondence: Joseph A. Murray, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. E-mail:

Guarantor of the article: Joseph A. Murray, MD.

Specific author contributions: Study concept and design: Joseph A. Murray, S. Vincent Rajkumar, Ola Landgren and Rok Seon Choung; analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content: Rok Seon Choung, Ivo C. Ditah, Ashley M. Nadeau, Eric V. Marietta, Alberto Rubio-Tapia, Joseph A. Murray, S. Vincent Rajkumar, Ola Landgren and James E. Everhart; statistical analysis: Rok Seon Choung and Ivo C. Ditah; administrative, technical, or material support: Tricia L. Brantner and Michael J. Camilleri; study supervision: Joseph A. Murray.

Financial support: This work was partly supported by the Centers for Disease Control Contract No. M26561.

Potential competing interests: Dr Murray has received grant funding from Alba Therapeutics and Alvine Pharmaceuticals, Inc., has served on an advisory board for Alvine Pharmaceuticals, Inc., and has served as a consultant for AMAG Pharmaceuticals, Entera Health, Inc., Sonomaceuticals, LLC, BioLineRx, and GlaxoSmithKline.

© The American College of Gastroenterology 2015. All Rights Reserved.
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