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Risk of Severe Covid-19 in Patients with Celiac Disease: A Population-Based Cohort Study

Authors Lebwohl B, Larsson E, Söderling J, Roelstraete B, Murray JA, Green PHR, Ludvigsson JF

Received 2 December 2020

Accepted for publication 21 January 2021

Published 18 February 2021 Volume 2021:13 Pages 121—130


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Eyal Cohen

Benjamin Lebwohl,1,2 Emma Larsson,3 Jonas Söderling,4 Bjorn Roelstraete,4 Joseph A Murray,5 Peter HR Green,1 Jonas F Ludvigsson1,4,6

1Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA; 2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; 3Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden; 4Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; 5Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; 6Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden

Correspondence: Jonas F Ludvigsson
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, PO Box 281, Stockholm, SE-17177, Sweden
Tel +46-19-6021000

Background: Patients with celiac disease (CeD) are at increased risk of certain viral infections and of pneumococcal pneumonia, raising concerns that they may be susceptible to severe coronavirus disease 2019 (Covid-19). We aimed to quantify the association between CeD and severe outcomes related to Covid-19.
Methods: We performed a population-based cohort study, identifying individuals with CeD in Sweden, as defined by small intestinal villus atrophy diagnosed at all (n=28) Swedish pathology departments during the years spanning 1969– 2017, and alive on February 1, 2020. We compared these patients to controls matched by sex, age, county, and calendar period. We performed Cox proportional hazards with follow-up through July 31, 2020, assessing risk of 1) hospital admission with a primary diagnosis of laboratory-confirmed Covid-19 (co-primary outcome); and 2) severe disease as defined by admission to intensive care unit and/or death attributed to Covid-19 (co-primary outcome).
Results: Among patients with CeD (n=40,963) and controls (n=183,892), the risk of hospital admission for Covid-19 was 2.9 and 2.2 per 1000 person-years respectively. After adjusting for comorbidities, the risk of hospitalization for Covid-19 was not significantly increased in patients with CeD (HR 1.10; 95% CI 0.80– 1.50), nor was the risk of severe Covid-19 increased (HR 0.97; 95% CI 0.59– 1.59). Results were similarly null when we compared CeD patients to their non-CeD siblings with regard to these outcomes. Among all patients with CeD and controls hospitalized with a diagnosis of Covid-19 (n=58 and n=202, respectively), there was no significant difference in mortality (HR for CeD compared to controls 0.96; 95% CI 0.46– 2.02).
Conclusion: In this population-based study, CeD was not associated with an increased risk of hospitalization for Covid-19 or intensive care unit and/or death attributed to Covid-19.

Keywords: Covid-19, celiac disease, epidemiology, infection, SARS-CoV-2

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