Introduction

We evaluated celiac disease (CeD)-related symptoms and comorbidities in two US healthcare databases after CeD diagnosis according to the presence/absence of CeD-related symptoms or comorbidities before diagnosis.

Aims & Methods

This matched case–control study used data from two US healthcare databases: 1) MarketScan^® Commercial and Medicare Supplemental database (collection period: 2002−2023); 2) Optum Clinformatics^® Data Mart (Optum CDM; collection period: 2007−2023). Patients with CeD had ≥ 1 inpatient or ≥ 2 outpatient International Classification of Diseases (ICD)-9 or -10 codes (579.0 and K90.0, respectively) at any time during the collection period. Patients were matched in a 1:5 ratio with controls without CeD (no CeD ICD-9/-10 codes at any time during data collection) for age at diagnosis, sex, region, and diagnosis year. All individuals had continuous medical and pharmacy enrollment for 2 years pre/post CeD diagnosis. Odds ratios (ORs) and 95% confidence intervals (CIs) for symptoms/comorbidities after CeD diagnosis were estimated by generalized multivariate logistic regression comparing cases vs matched controls stratified by those with (persistent) or without (new-onset) the relevant symptom/comorbidity pre-diagnosis. Symptoms assessed included abdominal pain, bloating, diarrhea, headache, nausea/vomiting, and tiredness. Comorbidities assessed included depression/anxiety, irritable bowel syndrome (IBS), and iron deficiency anemia (IDA).

Results

The numbers of CeD cases and controls were 39,814 and 198,961 in MarketScan, and 18,357 and 91,754 in Optum CDM, respectively. In both databases, CeD diagnosis was significantly positively associated with having CeD-related symptoms/comorbidities 2 years after CeD diagnosis regardless of pre-diagnosis status; and the strengths of associations were greater among patients with new-onset than with persistent symptoms/comorbidities after CeD diagnosis.
In MarketScan, the ORs (95% CI) in patients with new-onset symptoms were highest for bloating (7.98 [7.32–8.71]), diarrhea (6.83 [6.48–7.19]), and nausea/vomiting (3.75 [3.49–4.04]), and in those with new-onset comorbidities for IBS (8.30 [7.65–9.00]), IDA (6.35 [5.94–6.79]), and depression/anxiety (2.12 [2.04–2.20]). The ORs (95% CI) in patients with persistent symptoms were 2.47 (1.86–3.27) for bloating, 2.47 (2.21–2.76) for diarrhea, and 2.46 (2.05–2.96) for nausea/vomiting, and in those with persistent comorbidities were 1.38 (1.16–1.64) for IBS, 1.93 (1.70–2.18) for IDA, and 1.42 (1.34–1.51) for depression/anxiety.
In Optum CDM, the ORs (95% CI) in patients with new-onset symptoms were highest for bloating (6.15 [5.56–6.80]), diarrhea (5.85 [5.48–6.24]), and nausea/vomiting (3.38 [3.08–3.70]), and in those with new-onset comorbidities for IBS (6.17 [5.56–6.85]), IDA (5.31 [4.89–5.77]), and depression/anxiety (2.10 [1.99–2.21]). The ORs (95% CI) in patients with persistent symptoms were 2.25 (1.70–2.97) for bloating, 2.51 (2.22–2.84) for diarrhea, and 2.77 (2.23–3.43) for nausea/vomiting, and in those with persistent comorbidities were 1.40 (1.15–1.71) for IBS, 2.54 (2.17–2.97) for IDA, and 1.50 (1.38–1.62) for depression/anxiety.

Conclusion

CeD diagnosis was significantly associated with having CeD-related symptoms/comorbidities 2 years after CeD diagnosis, with greater associations among patients with new-onset symptoms/comorbidities than those with persistent symptoms/comorbidities. These results emphasize the clinical burden of CeD and the need for improved treatment options.

Disclosure

FZ has served as a speaker for Werfen and a consultant for Takeda. MA, SM, VG, SG, IP, NC, and DAL are employees and shareholders of Takeda Development Center Americas, Inc. and receive stock or stock options. BL has nothing to disclose.