Prevalence and Epidemiology of First Ever Occurrence of Ulcerative Colitis at Least 1 Month After Diagnosis of Celiac Disease in the United States: A Population-Based Study Between 2013 and 2018

Abstract

Introduction: Previous studies have suggested a possible association between Ulcerative Colitis (UC) and Celiac Disease (CeD). However, this link is controversial since most of these studies have been limited by small sample sizes. We sought to describe the risk of first ever occurrence of UC at least 1 month after a diagnosis of CeD in the United States (US) utilizing a large population based database. Methods: We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of Electronic Health Record data from 26 major integrated healthcare systems in the US from 1999 to 2018. We identified an aggregated patient cohort of eligible patients with “Celiac Disease” (CeD), “Ulcerative Colitis” (UC) and first ever occurrence of UC at least 1 month after a diagnosis of CeD between June 2013 and 2018, based on Systematized Nomenclature Of Medicine - Clinical Terms. We calculated the prevalence of UC, CeD and first ever UC at least 1 month post CeD among different patient groups<./p> Results: Of the 34,605,400 individuals active in the database from June 2013-2018, we identified 92,130 individuals with CeD with an overall prevalence rate of 0.27%, and 129,300 individuals with UC with an overall prevalence rate of 0.37%. Of the individuals with CeD, we identified 450 individuals who were diagnosed with first ever occurrence of UC at least 1 month after a diagnosis of CeD with a prevalence rate of 0.49% [OR: 1.41, 95% CI: 1.28-1.54, p<0.0001). Prevalence of first ever UC was higher in elderly (aged>65yrs) at 0.65%, compared to adults (aged 18-65yrs) at 0.48% and children at 0.18% [OR: 1.43, 95% CI: 1.17-1.75, p=0.0004]. Prevalence of first ever UC was higher in African-Americans at 0.60% compared to Caucasians at 0.50% [OR: 1.20, 95% CI: 0.77-1.89, p=0.4165]. Prevalence of first ever UC was nearly equivalent in males and females at 0.50% (Figure 1). The 5-year age-interval based prevalence rates of first ever occurrence of UC at least 1 month after a diagnosis of CeD is shown figure 2.742_A Figure 1. Prevalence (per 100) of first occurrence “Ulcerative Colitis” (UC), at least 1 month after a diagnosis of “Celiac Disease” (CeD) in the United States between 2013 and 2018Conclusion: This is one of the first large studies to date that has described the risk and epidemiology of first ever occurrence of UC at least 1 month after a diagnosis of CeD. We found that the estimated prevalence of first ever occurrence of UC at least 1 month after a diagnosis of CeD is 0.49%, higher compared to individuals without IBD and the general population. Further studies are needed to understand the mechanism of association between these disorders.742_B Figure 2. 5-year Age Interval Prevalence (per 100,000) of Ulcerative Colitis (UC), Celiac Disease (CeD), and first occurrence of Ulcerative Colitis, at least 1 month after a diagnosis of Celiac Disease (UC/CeD) in the United States between 2013 and 2018