Incidence of Celiac Disease Is Increasing Over Time: A Systematic Review and Meta-analysis

Am J Gastroenterol. 2020 Apr;115(4):507-525.doi: 10.14309/ajg.0000000000000523.

James A King 1, Jocelyn Jeong 1 2, Fox E Underwood 1 3, Joshua Quan 3, Nicola Panaccione 3, Joseph W Windsor 1 3, Stephanie Coward 1 3, Jennifer deBruyn 2, Paul E Ronksley 1, Abdel-Aziz Shaheen 1 3, Hude Quan 1, Jenny Godley 4, Sander Veldhuyzen van Zanten 5, Benjamin Lebwohl 6 7, Siew C Ng 8, Jonas F Ludvigsson 9 10, Gilaad G Kaplan 1 3


Author information

  • 1Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
  • 2Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
  • 3Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
  • 4Department of Sociology, University of Calgary, Calgary, Alberta, Canada.
  • 5Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • 6Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, New York, USA.
  • 7Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
  • 8Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China.
  • 9Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
  • 10Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.


Objectives: To conduct a systematic review and meta-analysis that defines the worldwide incidence of celiac disease (CD) and examines temporal trends.

Methods: MEDLINE and EMBASE were searched for population-based studies reporting the incidence of CD in the overall population, children, or adults. No limits were placed on year or language of publication. Studies solely examining at-risk populations (e.g., patients with type 1 diabetes) were excluded. Random-effects models were performed to meta-analyze sex- and age-specific incidence in the 21st century. Temporal trend analyses assessed the average annual percent change in CD incidence over time.

Results: Of 11,189 citations, 86 eligible studies were identified for inclusion, of which 50 were deemed suitable for analyses. In the 21st century, the pooled female incidence of CD was 17.4 (95% confidence interval [CI]: 13.7, 21.1) (I = 99.5%) per 100,000 person-years, compared with 7.8 (95% CI: 6.3, 9.2) (I = 98.6%) in males. Child-specific incidence was 21.3 per 100,000 person-years (95% CI: 15.9, 26.7) (I = 99.7%) compared with 12.9 (95% CI: 7.6, 18.2) (I = 99.9%) in adults. Pooling average annual percent changes showed the incidence of CD to be increasing by 7.5% (95% CI: 5.8, 9.3) (I = 79.6%) per year over the past several decades.

Discussion: Incidence of CD is highest in females and children. Overall, the incidence has been significantly rising in the latter half of the 20th century and into the 21st century throughout the Western world. Population-based studies in Africa, Asia, and Latin America are needed to provide a comprehensive picture of the global incidence of CD.

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