New Study Says that People with Celiac Disease May Die Earlier than Non-Celiacs

Celiac.com 04/15/2020 - We know that untreated celiac disease carries higher risks of early deaths from numerous related conditions, including lymphomas. We often get asked whether celiac disease causes people to die sooner than people without celiac disease. We don't know how much this risk might be reduced by wider diagnosis rates, less severe clinical disease, and more widespread availability of gluten-free food.

A team of researchers recently set out to evaluate the association between celiac disease and mortality risk in a population-based cohort in Sweden. Their results link celiac disease with a small, but statistically significant increased risk of death, but don't be too alarmed, just yet.

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For the study, the research team identified and followed all of the nearly 50,000 people diagnosed with celiac disease in Sweden, starting from the day after biopsy, between 1969 and 2017.  Each individual was matched with up to 5 control subjects in the general population by age, sex, county, and time frame. Researchers defined celiac disease as the presence of small intestinal villus atrophy on histopathology specimens during the years 1969-2017 from Sweden’s 28 pathology departments.

The primary outcome was all causes of death, and the secondary outcome was death by specific cause. The team then used stratified Cox proportional modeling to compared the results of celiac patients with controls, stratifying by year of diagnosis.

Their results show that people with celiac face a small, but statistically significant increased risk of death from cardiovascular disease, cancer, and respiratory disease. 

Basically, the study says that if you take all of the people with celiac disease, add up the ages of the subjects, and calculate the number of deaths per thousand person years, then that group of celiacs will have 9.7 deaths, while the general population will have 8.6 deaths, which is an ~11% higher death rate. 

They also noted that overall mortality risk was greatest in the first year after diagnosis, but persisted beyond 10 years after diagnosis. However, the results raise more questions than they answer. What about treated celiacs? Do they live longer than untreated celiacs? Is there a difference? Does gut healing and a gluten-free diet make a difference? The study doesn't answer those questions.

The study doesn't tell us anything about the effects of a gluten-free diet on overall mortality rates for celiacs, which is among the first questions celiacs might have. Was the increase due to celiacs who didn't follow a strict gluten-free diet?

Certainly, a statistically significant increased mortality risk warrants further study. For people with celiac disease who maintain good gut health with a gluten-free diet, the most relevant question will be whether a gluten-free diet and gut healing mitigate this higher risk in any appreciable way. 

This study lays the groundwork for further studies on the effects of gut healing and a gluten-free diet based on the slightly higher mortality risk for celiacs.

Read more at Jamanetwork.com