title: No increased mortality in 109,000 first-degree relatives of celiac individuals.
abstract: BACKGROUND
  Several studies have shown an excess mortality in individuals with celiac disease (CD). However, it is unknown if also first-degree relatives (FDRs) to celiac patients are at increased risk of death.
  
  
  OBJECTIVE
  We aimed to assess mortality in FDRs to celiac patients.
  
  
  METHODS
  Individuals with CD were identified through biopsy reports (equal to Marsh grade III). Each celiac individual was matched on sex, age, county and calendar year with up to five control individuals. Through Swedish healthcare registries we identified all FDRs (father, mother, sibling, offspring) of CD individuals and controls. Through Cox regression we calculated hazard ratios (HRs) for mortality (all-cause death, circulatory, cancer and other).
  
  
  RESULTS
  We identified 109,309 FDRs of celiac individuals and 549,098 FDRs of controls. Overall mortality was increased in FDRs to celiac individuals (HR=1.02, 95%CI=1.00-1.04, p=0.03). This corresponded to an excess risk of 5.9 deaths per 100,000 person-years of follow-up. When limiting follow-up to time since celiac diagnosis in the index individual, we found no increased risk of death (HR=1.01; 95%CI=0.98-1.03).
  
  
  CONCLUSIONS
  FDRs to individuals with CD are at increased risk of death. This excess risk is however minimal and unlikely to be of any clinical importance to the individual.
authors.affiliation: Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden; Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Norway. Electronic address: lojsankik@hotmail.com.
authors.forename: Louise
authors.initials: L
authors.lastname: Emilsson
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK; National Institute of Health Research Nottingham Digestive Diseases Centre Biomedical Research Unit, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK.
authors.forename: Alyshah
authors.initials: A
authors.lastname: Abdul Sultan
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002423:Cause of Death; D002446:Celiac Disease / Q000401:mortality* / Q000473:pathology*; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D035781:Siblings; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Coeliac; Death; Relatives; Shared genetics