title: Burden of celiac disease in the Mediterranean area.
abstract: OBJECTIVE
  To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost.
  
  
  METHODS
  For statistics regarding the population of each country in the Mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available confidence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic profiles amongst Mediterranean countries.
  
  
  RESULTS
  In the next 10 years, the Mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550,000 symptomatic adults and about 240,000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about €4 billion (€387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortality: about 600,000 celiac patients will die in the next 10 years, with an excess of 44.4% vs age- and sex-matched controls.
  
  
  CONCLUSIONS
  In the near future, the burden of CD will increase tremendously. Few Mediterranean countries are able to face this expanding epidemic alone.
authors.affiliation: European Laboratory for Food Induced Diseases, Federico II University of Naples, 80131 Naples, Italy. ydongre@unina.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Greco
authors.forename: Laura
authors.initials: L
authors.lastname: Timpone
authors.forename: Abdelhak
authors.initials: A
authors.lastname: Abkari
authors.forename: Mona
authors.initials: M
authors.lastname: Abu-Zekry
authors.forename: Thomas
authors.initials: T
authors.lastname: Attard
authors.forename: Faouzi
authors.initials: F
authors.lastname: Bouguerrà
authors.forename: Paskal
authors.initials: P
authors.lastname: Cullufi
authors.forename: Aydan
authors.initials: A
authors.lastname: Kansu
authors.forename: Dusanka
authors.initials: D
authors.lastname: Micetic-Turk
authors.forename: Zrinjka
authors.initials: Z
authors.lastname: Mišak
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Roma
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
authors.forename: Selma
authors.initials: S
authors.lastname: Terzic
mesh_terms: D000293:Adolescent; D000328:Adult; D002446:Celiac Disease / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D019083:Mediterranean Region / Q000453:epidemiology