S3432 Celiac Disease: A Nationwide Analysis of Epidemiological Trends and Outcomes from 2007–2017

Introduction: Celiac Disease (CD) is a common immune-mediated enteropathy precipitated by gluten in genetically susceptible individuals. In this study, we aimed to identify epidemiological trends and adverse outcomes associated with CD hospitalizations. Methods: The Nationwide Inpatient Sample (NIS) was analyzed from 2007–2017 to identify all adult (≥ 18 years) hospitalizations of CD using the ICD-9 and ICD-10 codes. Patients < 18 years were excluded. Epidemiological trends and adverse outcomes were identified. We used the Cochran-Armitage trend for trends of proportions of binary variables and a liner regression model for the trends of averages of continuous variables. SAS 9.4 was used for statistical analysis and P-values ≤ 0.05 were considered statistically significant. Results: From 2007–2017, we noted a trend towards increasing hospitalizations for CD from 19,385 in 2007 to 38,395 in 2017 (p-trend < 0.0001). A female predominance was noted for the study period with a trend towards increasing hospitalizations from 70.68% in 2007 to 73% in 2017 (p-trend < 0.0001), while CD hospitalizations for males were on a decline (Table 1). The mean age decreased from 59.8 years in 2007 to 56.8 years in 2017 (p-trend < 0.0001) with a trend towards decreasing mean age. Whites made up a majority of the study population and urban teaching hospitals were noted to have the most hospitalizations throughout the study period (Table 1). Additionally, we noted a rising trend for total hospital charge from $26,299 in 2007 to $49,282 in 2017 (p-trend < 0.0001). However, there was a trend towards decreasing length of stay from 4.88 days in 2007 to 4.59 days in 2017 (p-trend = 0.0015) and esophagogastroduodenoscopy (EGD) performed from 2.09% in 2007 to 1.89% in 2017 (p-trend < 0.0001). Inpatient mortality for CD hospitalizations increased from 1.30% in 2007 to 1.58% in 2017 (p-trend = 0.0002) with a trend towards increasing mortality. Conclusion: In the US, the total number of hospitalizations for CD were on the rise. The exact reason for this is currently unknown but may, in part, be due to increased awareness about the disease, widespread availability of serological screening and a rise in seroprevalence. The female predominance noted in our study was in line with current literature. Furthermore, we noted a trend towards increasing inpatient mortality, the mechanism of which is currently unknown but may be secondary to a state of persistent chronic inflammation and the association of CD with other co-morbidities.Table 1.: Epidemiological trends, hospital characteristics and adverse outcomes of Celiac Disease hospitalizations.