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epidemiology

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Prevalence

  • 1 in 50 to 1 in 200 people globally have celiac disease
  • Estimated ~70% remain undiagnosed and untreated
  • Diagnoses have increased in recent decades due to greater awareness and blood test availability
  • Still considered significantly underdiagnosed; more undiagnosed cases in poorer areas and countries without routine testing

Demographics

FactorDetail
Age of onsetMost develop disease before age 10
Age at diagnosis~20% diagnosed after age 60
SexSlightly more common in women than men (partly due to diagnostic bias — men with GI symptoms less likely to receive biopsy)

Geographic Distribution

  • Less common where gluten-containing crops are rarely eaten: parts of East Asia, sub-Saharan Africa
  • Higher prevalence in areas where HLA-DQ2/DQ8 genes are common (regions with long wheat-eating history)
  • The HLA-DQ2 gene may have been evolutionarily favoured as it appears to help protect against tooth decay — which may explain its persistence despite the disease burden

High-Risk Populations

GroupRisk
First-degree relatives of celiac patientsSubstantially elevated
Second-degree relativesMildly elevated
Type 1 diabetesComorbid autoimmune association
Autoimmune thyroid disease (hyper- and hypothyroid)Comorbid autoimmune association
Down syndromeElevated
Turner syndromeElevated
IgA deficiencyElevated (~1 in 40 celiac patients have IgA deficiency)
  • Prevalence of HLA-DQ2 genotype + gluten consumption has increased over time (due to diet changes)
  • Despite expectations that HLA-DQ2 should become less common, it remains stable or increases in populations with high wheat consumption

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