title: Socioeconomic variation in the incidence of childhood coeliac disease in the UK.
abstract: BACKGROUND
  Serological studies indicate that evidence of coeliac disease (CD) exists in about 1% of all children, but we lack estimates of current diagnostic patterns among children and how they vary by socioeconomic group.
  
  
  METHODS
  We identified all children aged 0-18 years between 1993 and 2012 who were registered with general practices across the UK that contribute to a large population-based general practice database. The incidence of CD was evaluated in each quintile of the Townsend index of deprivation and stratified by age, sex, country and calendar year.
  
  
  RESULTS
  Among 2,063,421 children, we identified 1247 CD diagnoses, corresponding to an overall CD incidence of 11.9 per 100,000 person-years, which was similar across the UK countries and higher in girls than in boys. We found a gradient of CD diagnosis across socioeconomic groups, with the rate of diagnosis being 80% higher in children from the least-deprived areas than in those from the most-deprived areas (incident rate ratio 1.80, 95% CI 1.45 to 2.22). This pattern held for both boys and girls and across all ages. Across all four countries of the UK, we found similar associations between CD and socioeconomic status. While CD incidence up to age 2 remained stable over the study period, diagnoses at older ages have almost tripled over the past 20 years.
  
  
  CONCLUSIONS
  Children living in less socioeconomically deprived areas in the UK are more likely to be diagnosed with CD. Increased implementation of diagnostic guidelines could result in better case identification in more-deprived areas.
authors.affiliation: Division of Epidemiology and Public Health, City Hospital Campus, University of Nottingham, Nottingham, UK Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Zingone
authors.affiliation: Division of Epidemiology and Public Health, City Hospital Campus, University of Nottingham, Nottingham, UK.
authors.forename: Joe
authors.initials: J
authors.lastname: West
authors.affiliation: Division of Epidemiology and Public Health, City Hospital Campus, University of Nottingham, Nottingham, UK.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Crooks
authors.affiliation: Division of Epidemiology and Public Health, City Hospital Campus, University of Nottingham, Nottingham, UK.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Fleming
authors.affiliation: Division of Epidemiology and Public Health, City Hospital Campus, University of Nottingham, Nottingham, UK.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Card
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Ciacci
authors.affiliation: Division of Epidemiology and Public Health, City Hospital Campus, University of Nottingham, Nottingham, UK.
authors.forename: Laila J
authors.initials: LJ
authors.lastname: Tata
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002446:Celiac Disease / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D058006:General Practice; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012737:Sex Factors; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: children; coeliac disease; incidence; socioeconomic status