The Burden Of Concurrent Autoimmune Diseases In Hospitalized Patients With Celiac Disease: A National Cohort Study

INTRODUCTION: Celiac disease (CD) is an autoimmune disorder known to be associated with multiple other autoimmune conditions. In this study, we aimed to quantify the association between the CD and some most common autoimmune conditions systematically and further investigate the impact of concurrent gastrointestinal (GI) autoimmune diseases on its in-hospital outcomes. METHODS: In this retrospective cohort study, the 2014 National Inpatient Sample database was analyzed by using ICD-9 Code for hospitalizations with a primary or secondary diagnosis as celiac disease. The primary outcome of interest was the prevalence of concurrent autoimmune diseases. The secondary outcomes were the impact of the concurrent GI autoimmune conditions on its in-hospital outcomes including mortality, length of stay, and total charge. Multivariate regression was used to adjust for age, gender, and race to calculate the odds ratio of concurrent autoimmune diseases and further adjust for the Charlson comorbidity index for in-hospital outcomes. STATA 14 (College Station, TX) was used for analysis. RESULTS: There was a total of 39,215 patients with celiac disease who were hospitalized in 2014, which was about 0.11% of all hospitalizations. In comparison to patients without celiac diseases, those patients were older, and more likely to be female and white. In comparison to the control group, patients with celiac disease had a significantly higher rate of having concurrent autoimmune conditions [19.56% vs 4.96%, odds ratio: 4.16 (95% CI: 3.89–4.43)]. Celiac disease was also associated with a higher rate of coexisting GI autoimmune diseases compared to the control group [4.53% vs 1.00%, odds ratio: 4.34 (95% CI: 3.85–4.89)]. In patients hospitalized with celiac disease, concurrent GI autoimmune disease was associated with a significantly longer length of stay (Coefficient: 0.56, 95% CI: 0.09–1.03, P < 0.05). The impact on its in-hospital all-cause mortality (Odds ratio: 1.40, 95% CI: 0.50–3.97, P = 0.52) and total charge (Coefficient: 4663, 95% CI: −2619 to 11946, P = 0.21) was not statistically significant. CONCLUSION: Celiac disease was associated with a significantly higher burden of concurrent autoimmune conditions including other autoimmune diseases of the GI system. This association highlights the possible shared pathogenic mechanism and the need for optimal strategies to diagnose other autoimmune conditions in patients with CD.Table 1.: Comparison of demographics and concurrent autoimmune conditions in hospitalized patients with celiac disease vs without celiac disease