S1379 Celiac Disease on the Rise in the U.S. Military Population: Epidemiology and Impact on Operational Readiness

Abstract

Introduction: Celiac disease (CD) is an increasingly common disease that affects approximately 1% of the global population and 1-2% of Americans. Recent population based data suggests an increase in the prevalence over the last several decades. Given this is a diagnosis that can preclude induction to the military and deployment to austere environments, we conducted a study to better define the epidemiology of celiac disease in the US military population Methods: Data were collected from the Defense Medical Surveillance System (DMSS) with a surveillance period of January 1, 2000, through December 31, 2017. The population included active component military service members of the US Army, Navy, Air Force, and Marine Corps who served during the period. An individual was counted as a case if they had at least 1 outpatient encounter with a qualifying International Classification of Diseases (ICD), Ninth and Tenth Revision code in any diagnostic position. Diagnoses from all military treatment facility clinics and gastroenterology (GI) specialty clinics only were included in this analysis to increase the specificity a celiac disease diagnosis. Results: A total of 3138 cases (888 within GI clinics) of CD were identified over the surveillance period. The annual incidence rates increased from 3.0 (1.5 within GI clinics) per 100,000 person-years in 2000 to 21.4 (6.5 within GI clinics) per 100,000 person-years in 2017. The prevalence rate increasing from 7.0 per 100,000 service members (3.3 within GI clinics) in 2000 to 87.9 per 100,000 service members (24.7 within GI clinics) in 2017. Prevalence was highest in women (181.8 vs 70.0 per 100,000 service members), age 46 and above (315.5 vs average of 121.1 per 100,000 service members) and white-non Hispanic (112.4 vs average of 57.1 per 100,000 service members). Conclusion: In a retrospective review of the DMSS over 18 years, the incidence and prevalence of CD within the US military is increasing; this may impact operational readiness and health and wellness of our military members. The incidence and prevalence varies with gender, age, and ethnicity. There is a need for further studies examining the military specific aspects of care for members with CD.