title: Neighborhood conditions and celiac disease risk among children in Sweden.
abstract: OBJECTIVE
  To investigate celiac disease (CD) clustering at different geographical levels and to examine the association between neighborhood demographic and socioeconomic conditions and the risk of neighborhood CD.
  
  
  METHODS
  We included 2080 children diagnosed with CD between 1998 and 2003, identified from 43 of the 47 reporting hospitals in Sweden. A total of 8036 small area market statistics (SAMS) areas were included; these were nested in 253 municipalities that were further nested into eight 'nomenclature of territorial units for statistics' (NUTS) 2 regions. We performed multilevel logistic regression analyses.
  
  
  RESULTS
  We found the highest geographical variation in CD incidence at the municipality level, compared to the region level. The probability of having CD increased in the statistical areas of (SAMS) areas with higher average annual work income, with an odds ratio (OR) of 2.24 and 95% CI of 1.76-2.85. Reduced CD risk in neighborhoods was associated with higher average age (OR 0.96; 95% CI 0.95-0.97), higher proportion of residents with a university education (OR 0.98; 95% CI 0.97-0.99), and higher level of industrial and commercial activity (OR 0.59; 95% CI 0.44-0.82). We found no significant association between CD risk and population density, proportion of Nordic to non-Nordic inhabitants, nor share of the population with only a compulsory education.
  
  
  CONCLUSIONS
  Neighborhood composition influences cd risk this is one of the first attempts to identify factors explaining geographical variation in CD.
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå; Sweden fredinah.namatovu@epiph.umu.se.
authors.forename: Fredinah
authors.initials: F
authors.lastname: Namatovu
authors.affiliation: Department of Geography and Economic History, Umeå University, Umeå, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Strömgren
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå; Sweden.
authors.forename: Anneli
authors.initials: A
authors.lastname: Ivarsson
authors.affiliation: Department of Geography and Economic History, Umeå University, Umeå, Sweden.
authors.forename: Urban
authors.initials: U
authors.lastname: Lindgren
authors.affiliation: Department of Food and Nutrition, Umeå University, Umeå, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Olsson
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå; Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Lindkvist
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå; Sweden Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Sandström
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D006801:Humans; D007223:Infant; D016015:Logistic Models; D055361:Multilevel Analysis; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology
keywords: Celiac disease; Sweden; demographics; education; environmental risk factors; geography; income; neighborhoods; socioeconomic conditions