title: Risks of hospitalization and drug consumption in children and young adults with diagnosed celiac disease and the role of maternal education: a population-based matched birth cohort study.
abstract: BACKGROUND
  Celiac disease (CD) may affect healthcare use in children and young adults. Socio-economic factors may act as a confounder or effect modifier. We assessed such hypotheses in a population-based birth cohort of young celiac subjects and references matched by maternal education.
  
  
  METHODS
  The cohort included all newborns recorded in the Medical Birth Register of Friuli-Venezia Giulia Region (Italy) between 1989 and 2011. CD incident cases were identified through pathology reports, hospital discharges and copayment exemptions and matched with up to five references by sex, year of birth and maternal education. Cox regression models were used to estimate Hazard Ratios (HRs) for major causes of inpatient diagnosis and drug prescription occurring after diagnosis in CD patients compared to references, stratifying by time of first event and maternal education.
  
  
  RESULTS
  We identified 1294 CD cases and 5681 references. CD cases had a higher risk of hospital admission for any cause (HR: 2.34; 95 % CI 2.08-2.63) and for all major ICD9-CM categories except obstetric complications, skin and musculoskeletal diseases, and injuries and poisoning. Prescription of all major ATC drug categories, except dermatologicals and genito-urinary medications, was significantly increased in CD subjects. For most outcomes, HRs were highest in the first year after CD diagnosis but remained significant after five or more years. HRs were similar across different categories of maternal education.
  
  
  CONCLUSIONS
  Diagnosed CD subjects had a higher risk of hospitalization and medication use compared to the general population, even five or more years after diagnosis, with no effect modification of maternal education.
authors.affiliation: Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, via Loredan 18, 35131, Padua, Italy. cristina.canova@unipd.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: Canova
authors.affiliation: Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, via Loredan 18, 35131, Padua, Italy. gisella.pitter@studenti.unipd.it.
authors.forename: Gisella
authors.initials: G
authors.lastname: Pitter
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden. jonasludvigsson@yahoo.com.|Department of Pediatrics, Örebro university Hospital, Örebro, 70185, Sweden. jonasludvigsson@yahoo.com.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
authors.affiliation: Friuli-Venezia Giulia Regional Health Information System, Informatica per il Sistema degli Enti Locali (INSIEL) S.p.A., Udine, Italy. pierantonio.romor@insiel.it.
authors.forename: Pierantonio
authors.initials: P
authors.lastname: Romor
authors.affiliation: Epidemiological Service, Health Directorate, Friuli Venezia-Giulia Region, Udine, Italy. loris.zanier@regione.fvg.it.
authors.forename: Loris
authors.initials: L
authors.lastname: Zanier
authors.affiliation: Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, via Loredan 18, 35131, Padua, Italy. renzo.zanotti@unipd.it.
authors.forename: Renzo
authors.initials: R
authors.lastname: Zanotti
authors.affiliation: Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, via Loredan 18, 35131, Padua, Italy. lorenzo.simonato@unipd.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Simonato
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002446:Celiac Disease / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012042:Registries; D012107:Research Design; D012307:Risk Factors; D055815:Young Adult
chemical_list: D055553:Prescription Drugs