Racial Differences in the Prevalence of Celiac Disease in the US Population: National Health and Nutrition Examination Survey (NHANES) 2009–2012 - Digestive Diseases and Sciences

Aim

To provide an estimate of the prevalence of celiac disease by race/ethnic origin in large sample of US population.

Methods

Data from the 2009–2010 and 2011–2012 NHANES were combined and analyzed. The NHANES is a nationally representative survey with oversampling of certain minorities. Sample-based frequencies were reported and weighted frequencies were used to estimate prevalence.

Results

A total of 14,701 participants were checked for tissue transglutaminase (tTG) and endomysial (EMA) IgA antibodies. Seventy-four participants had positive tTG and/or EMA corresponding to prevalence of 0.79 % (95 % CI 0.54–1.04 %). Non-Hispanic white were more likely to be positive for both compared with other races (72.0 vs 31.7 %; p = 0.010) and less likely to be weakly positive for tTG but positive for EMA (3.6 vs 26.4 %; p = 0.03). The prevalence of positive serology according to race was as follows: 1.08 % (95 % CI 0.70–1.45 %) in non-Hispanic white, 0.23 % (95 % CI 0.03–0.43 %) in Mexican, 0.22 % (95 % CI 0.01–0.44 %) in non-Hispanic black, 0.38 % (95 % CI 0.00–0.89 %) in “other Hispanic,” and 0.15 % (95 % CI 0.00–0.34 %) in other races including multiracial and undeterminable in non-Hispanic Asian due to the presence of only one positive EMA test. 0.9 % of the NHANES sample participants followed gluten-free diet. Of this group of participants, 85 % were never diagnosed with celiac disease and 99 % of them had negative celiac disease serology.

Conclusions

Potentially 0.79 % of the general US population demonstrate serologic evidence of celiac disease autoimmunity. The prevalence is 4–8 times higher among non-Hispanic white compared with other races. Close to 1 % of the population is electively following gluten-free diet despite having little evidence of the disease.

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Author notes

Authors and Affiliations

1. Lexington VA Medical Center, University of Kentucky College of Medicine, 800 Rose Street, Room MN649, Lexington, KY, 40536, USA

   Houssam E. Mardini

2. University of Kentucky College of Public Health, Lexington, KY, USA

   Philip Westgate

3. Miller School of Medicine, University of Miami, Miami, FL, USA

   Alla Y. Grigorian

Corresponding author

Correspondence to Houssam E. Mardini.