Celiac Disease Is More Common in Women but Men Have More Comorbidities and Higher Inhospital Mortality Compared With Women

Abstract

Introduction: Celiac Disease (CD) is more common in women. We assessed gender differences in medical comorbidities and mortality in inpatients with CD. We hypothesize that men with CD have more medical comorbidities and higher in-hospital mortality. Methods: Using the National Inpatient Sample, we identified consecutive pts with celiac disease (ICD 9 CM: 579.0) between 2004 and 2012. Pts were then classified based on gender into Men-CD and Women-CD and compared for age, ethnicity, insurance status, medical comorbidities and in-hospital mortality. Analyses were performed using SAS version 9.3. Results: During the study period, 44,441 pts with CD were admitted to hospitals in United States. Of these, 13,290 Men-CD and 31,151 Women-CD were identified, with a Men-CD to Women-CD ratio of 1:2.3. As compared with Women-CD, Men-CD were more likely to be smokers (9.5%, 8.3%, p < 0.0001) and have more frequent comorbidities including DM (21.6%, 17.1%, p < 0.0001), Hyperlipidemia (22.8%, 18.1%, p < 0.0001), COPD (1.3%, 0.7%, p < 0.0001), CHF (10.0%, 7.9%, p < 0.0001), Atrial Fibrillation (11.6%, 8.7%, p < 0.0001), Coronary artery disease (23.6%, 11.6%, p < 0.0001), Chronic liver disease (5.2%, 3.7%, p < 0.0001), Acute pancreatitis (2.3%, 1.9%, p=0.005), Chronic pancreatitis (1.6%, 1.3%, p=0.01), and Gout (4.2%, 1.2%, p < 0.0001). Men-CD were also more likely to have Dermatitis herpetiformis (1.2%, 0.5%, p < 0.001) and Down's syndrome (1.7%, 0.6%, p < 0.0001).Women-CD were alternatively more likely to be obese (6.0%, 2.9%, p < 0.0001), have hypothyroidism (22.7, 11.6%, p < 0.0001) and present with Acute appendicitis (0.6%, 0.2%, p=0.04).There were no statistically significant differences among the two groups for iron deficiency anemia (2.6%, 9.0%, p=0.49), Cholelithiasis (1.9%, 2.1%, p=0.31), Clostridium difficile infection (1.7%, 1.6%, p=0.28), Ulcerative colitis (0.3%, 0.3% p=0.99) and Crohn's disease (2.0%, 2.0%, p=0.85).There were also no differences in episodes of bowel perforation (0.2%, 0.1%, p=0.34) or bowel resection (0.6%, 0.5%, p=0.1). Men-CD had a higher in-hospital mortality (1.7%, 1.1%, p < 0.0001) compared with Women-CD. Conclusion: Similar to prior studies, CD is more common among women. However, men with CD have increased comorbidities and higher in-hospital mortality compared with women. CD-Men may benefit from more aggressive inpatient management of their medical co-morbidities to potentially reduce inhospital poor-outcomes.