The Epidemiology of Childhood Celiac Disease: A Social Epidemiological Perspective on Perinatal Factors

Abstract: Celiac disease is a chronic gastrointestinal disease affecting approximately 1% of the population. It is precipitated in genetically predisposed individuals by ingestion of food containing gluten or similar proteins that are present in wheat, rye and barley. The disease might present with symtoms such as malnutrition, diarrhea or abdominal bloating, but a large proportion of those afflicted by the disease are asymptomatic. We set out to study risk factors for celiac disease in children using a social epidemiological approach; besides the individual risk factors we also consider the importance of societal structures in conditioning disease risk. We investigated all children born in Sweden between 1987 and 1993 by linking several nationwide registers. We apply epidemiological methods such as multilevel analyses and sibling designs in order to approach causality. We observed that children exposed to adverse perinatal circumstances such as being born small for gestational age, born in families with lower socioeconomic position or having a congenital anomaly had a higher risk of CD. These associations were stronger in boys. We also observed that maternal CD seems not to be the cause of the previously reported increased risk of CD in girls. Furthermore, we observed that maternal length of stay in Sweden seems to affect the risk of CD in second-generation immigrant children. Future studies are needed to investigate risk factors for celiac disease in children; focusing especially on the mechanisms behind the observed associations.