Original Contribution | Published:

Colon/Small Bowel

The Prevalence of Celiac Disease in the United States

The American Journal of Gastroenterology volume 107, pages 15381544 (2012) | Download Citation

Abstract

OBJECTIVES:

The prevalence of celiac disease (CD) in the United States is unknown. We sought to estimate CD prevalence nationwide by using a nationally representative sample.

METHODS:

This study included 7,798 persons aged 6 years or older who participated in the National Health and Nutrition Examination Survey 2009–2010. Serum samples from all participants were tested for immunoglobulin A (IgA) tissue transglutaminase antibodies and, if findings were abnormal, also for IgA endomysial antibodies. Information about prior diagnosis of CD and use of a gluten-free diet (GFD) was obtained by direct interview. CD was defined as having either double-positive serology (serologically diagnosed CD) or a reported diagnosis of CD by a doctor or other health-care professional and being on a GFD (reported clinical diagnosis of CD).

RESULTS:

CD was found in 35 participants, 29 of whom were unaware of their diagnosis. Median age was 45 years (interquartile range, 23–66 years); 20 were women and 29 were non-Hispanic white. The prevalence of CD in the United States was 0.71% (95% confidence interval (CI), 0.58–0.86%), with 1.01% (95% CI, 0.78–1.31%) among non-Hispanic whites. In all, 55 participants reported following a GFD, which corresponded to a prevalence of 0.63% (95% CI, 0.36–1.07%).

CONCLUSIONS:

The prevalence of CD in the United States was 0.71% (1 in 141), similar to that found in several European countries. However, most cases were undiagnosed. CD was rare among minority groups but affected 1% of non-Hispanic whites. Most persons who were following a GFD did not have a diagnosis of CD.

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Acknowledgements

We thank Danita Byrd-Clark of Social and Scientific System, Silver Spring, MD for her help with data programming and statistical analysis and the staff of the Immunodermatology Laboratory of Mayo Clinic for indirect immunofluorescence assays.

Author information

Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

    • Alberto Rubio-Tapia
    • , Tricia L Brantner
    •  & Joseph A Murray
  2. Department of Pediatrics, Orebro University Hospital, Orebro, Sweden

    • Jonas F Ludvigsson
  3. Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden

    • Jonas F Ludvigsson
  4. Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA

    • James E Everhart
  5. J.A.M. and J.E.E. are co-senior authors

    • Joseph A Murray
    •  & James E Everhart

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Competing interests

Guarantor of the article: James E. Everhart, MD, MPH and Joseph A. Murray, MD.

Specific author contributions: study concept and design: James E. Everhart and Joseph A. Murray; analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content: Alberto Rubio-Tapia, Jonas F. Ludvigsson, Joseph A. Murray and James E. Everhart; statistical analysis: Alberto Rubio-Tapia and James E. Everhart; obtained funding: James E. Everhart; administrative, technical, or material support: Tricia L. Brantner; study supervision: James E. Everhart and Joseph A. Murray.

Financial support: This work was supported by the Centers for Disease Control Contract No. M26561, American College of Gastroenterology Junior Faculty Development Award (A.R.-T.), the Swedish Research Council and the Fulbright Commission (J.F.L.).

Potential competing interests: None.

Corresponding author

Correspondence to Joseph A Murray.

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DOI

https://doi.org/10.1038/ajg.2012.219