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Dr Lisa Whyte ST7 Gastroenterology Dr Huw Jenkins Coeliac UK - - PowerPoint PPT Presentation
Dr Lisa Whyte ST7 Gastroenterology Dr Huw Jenkins Coeliac UK - - PowerPoint PPT Presentation
Dr Lisa Whyte ST7 Gastroenterology Dr Huw Jenkins Coeliac UK Research Conference 2013 Median age Total New cases Patients Patients Targeted number per year with GI with non GI screening symptoms symptoms % % % 1983 89 4 11 1.8 88 12
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Median age Total number New cases per year Patients with GI symptoms % Patients with non GI symptoms % Targeted screening %
1983‐89 4 11 1.8 88 12 1990‐98 7.5 25 3.1 75 14 11 1999‐2004 8 50 10 42 32 26 2005‐2011 14 163 27 41 23 36
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Genetic factors
- HLA DQ2 and DQ8
- Syndromes
Environmental factors
- <2 years at diagnosis – low birth weight and neonatal
infections
- being born in the summer months
- artificial feeding
- early weaning onto a gluten containing diet
- multiple infections in the first year of life
- maternal smoking
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Low SES as a risk factor
- Swedish prospective epidemiological study ‐
in boys less than 2 years of age Ivarsson
A, Best practise and research clinical gastroenterology 2005
- Oxford record linkage study Roberts SE, Aliment Pharmacol
Ther 2009
High SES as a risk factor
- Poor Russian Karelia and wealthy area of neighbouring Finland Kondrashova
A et al. Ann Med 2008
- Unpublished PhD from the Sheffield/Nottingham Lewis NR et al 2007
▪ Incidence rate 2x > higher in higher socioeconomic groups (0.17/1000 vs 0.07/1000)
No difference
- Scottish study White LE et al. Arch Dis
Child 2012
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- Cross sectional study
- Paediatric CD patients
- Same tertiary medical centre
- Jan 1995 and Dec 2011
- Data
- age at diagnosis
- postcode at diagnosis
- linked with quintile rank of the Welsh Index of
Multiple Deprivation (WIMD) score 2008
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Total paediatric population for Cardiff, the Vale of Glamorgan, Newport and Powys
Adult population of Cardiff and the Vale of Glamorgan
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Prevalence rates by quintile of rank of WIMD 2008 score
Multivariate logistic regression analyses – confounders e.g. age and gender
A separate analysis of the WIMD in <2y olds
WIMD quintile vs Townsend deprivation quintile
SPSS version 18
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Measure of how deprived an area is within Wales (8 different types)
Deprivation ranks are calculated for each area according to how deprived they are relative to each other
Overall deprivation for the people living in that area (specific households may have very different levels of deprivation)
Townsend deprivation score has similar limitations
Using WIMD and Townsend deprivations scores to provide evidence the association
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253 children
33 cases could not be linked to an LSOA (21 children) – incorrect postcode/new housing
2 postcodes were from out with the geographical area and so these were excluded
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232 children (130 female and 102 male)
Age range at diagnosis was 0.8 to 16 years (median 7.4 years)
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Lowest deprivation Low deprivation Mid deprivation High deprivation Highest deprivation Total Num (Rate/1000) Num (Rate/1000) Num (Rate/1000) Num (Rate/1000) Num (Rate/1000) Num (Rate/1000) No Coeliac 66920 48651 42223 63110 77394 298298 Coeliac 78 (1.16) 45 (0.92) 25 (0.59) 46 (0.73) 38 (0.49) 232 (0.78) Total 66998 48696 42248 63156 77432 298530
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- Prevalence rate of children with CD in Cardiff, Vale
- f Glamorgan, Newport and Powys was 0.78 per
1000
- Graded association between frequency of
diagnosis of CD and SES
- Higher rate in children living in more affluent areas
- Difference between the lowest and highest
deprivation quintile is the most significant
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Health seeking behaviours
- More likely to seek advice for minor symptoms
- More likely to attend for screening if risk factors
Hygiene hypothesis
- early colonisation with a “normal”
microbacterial flora encourages regulation and maturation of the immune system
- higher SES group the exposure to foreign antigens is much
reduced
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