title: Long-term mortality in people with celiac disease diagnosed in childhood compared with adulthood: a population-based cohort study.
abstract: BACKGROUND
  To explore whether the excess mortality in celiac disease is related directly to the disease and duration of gluten exposure before diagnosis we have examined the long-term mortality experience of people with celiac disease diagnosed as children and as adults.
  
  
  METHODS
  Two hundred eighty-five children and 340 adults diagnosed with celiac disease were followed until death, loss to follow-up, or December 31, 2004. We calculated standardized mortality ratios (SMRs).
  
  
  RESULTS
  All-cause mortality more than 5 yr after diagnosis was increased threefold in children (SMR 3.32, 95% CI 2.05-5.07) compared with only a 38% increase in adults (SMR 1.38, 95% CI 1.16-1.63). This excess mortality in children was primarily because of an increased risk of death from accidents, suicide, and violence (seven deaths, SMR 3.22, 95% CI 1.29-6.63), cancer (five deaths, SMR 3.72, 95% CI 1.21-8.67), and cerebrovascular disease (two deaths, SMR 10.03, 95% CI 1.21-36.00).
  
  
  CONCLUSIONS
  Children diagnosed with celiac disease had a threefold increased risk of long-term mortality. This is in marked contrast to the experience of adult celiac disease where the long-term increase of mortality was modest. The increased mortality in children from external causes may reflect behavioral change associated with coping with a chronic disease and its treatment.
authors.affiliation: University of Nottingham, Division of Epidemiology and Public Health, Medical School, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
authors.forename: Masoud
authors.initials: M
authors.lastname: Solaymani-Dodaran
authors.forename: Joe
authors.initials: J
authors.lastname: West
authors.forename: Richard F A
authors.initials: RF
authors.lastname: Logan
mesh_terms: D000328:Adult; D002423:Cause of Death; D002446:Celiac Disease / Q000175:diagnosis / Q000401:mortality*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology