title: Factors associated with long diagnostic delay in celiac disease.
abstract: OBJECTIVE
  Here, we investigated the factors associated with long diagnostic delay in celiac disease and the impact of the national Current Care Guidelines in reducing the delay.
  
  
  METHODS
  This population-based study involved 825 adult celiac disease patients. The diagnosis was considered delayed when the interval between first symptoms and diagnosis was >10 years. The patients were asked about the duration and type of symptoms before diagnosis, time and site (tertiary, secondary, or primary care) of the diagnosis, family history of the disease, and presence of significant comorbidities. Analysis was performed by binary logistic regression.
  
  
  RESULTS
  Altogether, 261 (32%) out of 825 participants reported a diagnostic delay of >10 years. Female gender, neurological or musculoskeletal disorders and presence of diarrhea, abdominal pain, and malabsorption were associated with prolonged delay. Male gender, diagnosis after the introduction of the first Current Care Guidelines in 1997, and being detected by serological screening, and family history of celiac disease were associated with a lower risk of delayed diagnosis. Factors not associated with the delay were site of diagnosis, age, and presence of dermatitis herpetiformis, type 1 diabetes, or thyroidal disease.
  
  
  CONCLUSIONS
  The number of long diagnostic delays in celiac disease has decreased over the past decades. The shift of diagnostics from secondary and tertiary care to primary care has not been detrimental. National guidelines together with increased awareness and active screening in at-risk groups of celiac disease are important in these circumstances.
authors.affiliation: Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital , Tampere , Finland.
authors.forename: Valma
authors.initials: V
authors.lastname: Fuchs
authors.forename: Kalle
authors.initials: K
authors.lastname: Kurppa
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology; D057210:Delayed Diagnosis; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D012307:Risk Factors; D013997:Time Factors
keywords: adults; celiac disease; current care guidelines; diagnostic delay