Celiac Disease in the US Military: Incidence, Trends and Deployment Risk Factors: 2010 Presidential Poster

Abstract

Purpose: Celiac disease (CD) is an increasingly common disorder that may affect as many as 1% of the North American population. Recent population-based data suggest a substantial increase in the prevalence of celiac disease over the last several decades. Several factors are hypothesized as possible disease triggers including inter-current illnesses, such as gastroenteritis, surgeries, and trauma. The active duty US military represents a unique healthy worker population with essentially complete medical diagnostic coding and opportunity to describe trends in CD and deployment related risk factors. Methods: Data from the Defense Medical Encounter Database were extracted from 1999 to 2008 to analyze trends. Diagnosis of CD was based on a first medical encounter with an ICD-9 diagnostic code of 579.0 in the first diagnostic position. Incidence rates were estimated for the active duty population overall, and stratified by age, service branch, and gender. Additional data from a nested case-control study will be reported describing specific deployment related risk factors. Results: Between 1999 and 2008 there was an average of 1.38 million active duty service members followed annually. During this time period, the incidence of CD was observed to increase from 4.1 per 100K in 1999 to 22.4 per 100K in 2008, an average yearly increase of 1.8 cases/100K/year. Highest rates of increase were among the 35-39 and over 40 age strata (increase of 2.8 and 3.6 incident cases per 100K/year). Across years, rates were over 3 times higher in females compared to males (30.4 vs. 8.6 per 100K), greater among Air Force (17.2 per 100K) and Navy (13.8 per 100K), and among Caucasians (15.5 per 100K, African-American 2.3, other 6.9). Deployment related risk factors including infectious gastroenteritis will be described. Conclusion: Incidence of CD in the US military is increasing, particularly among the older age population and while most frequent in Caucasians does occur in other ethnicities. While difficult to compare to other populations, it does provide robust measure of incidence in a large population. This likely represents an important underestimate of the burden of disease. Service specific differences were noted and deployment related risks, including stress and infectious gastroenteritis need to be explored.Figure: Incidence of Celiac Disease based on ICD-9 visit among US Military by age strata, 1999-2008.