Burden of celiac disease in the Mediterranean area

Table 1 Excess need of health resources before the diagnosis of celiac disease

	n	Adult cost (€)	n	Child cost (€)
In-patient admission	2	9818	1	2254
Out-patient admission	1	879	1	586
Medical consultations	3	100	3	150
Specialist consultations	2	150	1	50
Lab test	4	446	2	297
Total per patient		11 393		3337

Table 2 Populations now and after 10 years

	Population	Children 0-14	Median age (yr)	Population growth rate (%)	Children 0-14 in 10 yr	Total population in 10 yr
Albania	3 619 778	853 883	29.9	0.5	901 667	3 822 345
Algeria	33 769 669	8 878 665	26.6	1.2	9 999 566	38 032 972
Bosnia	4 590 310	673 770	39.8	0.3	696 962	4 748 317
Cyprus	792 604	154 445	35.5	1.7	182 623	937 214
Croatia	4 491 543	708 683	41	-0.1	705 006	4 468 242
Egypt	81 713 517	25 983 672	24.8	2	31 776 575	99 931 053
France	64 057 790	11 894 698	39.4	0.5	12 564 088	67 662 729
Greece	10 722 816	1 531 606	41.8	0.1	1 551 169	10 859 777
Israel	7 112 359	1 989 312	29.1	1.7	2 347 869	8 394 303
Italy	58 126 212	7 870 226	43.3	0	7 833 314	57 853 596
Lebanon	3 971 941	1 032 888	29.3	1.1	1 153 096	4 434 197
Libya	6 173 579	2 048 548	23.9	2.2	2 539 599	7 653 427
Malta	403 532	66 112	39.5	0.4	68 805	419 967
Morocco	34 343 219	10 473 478	25	1.1	11 683 138	8 309 775
Syria	19 747 586	7 146 569	21.7	2	8 716 754	24 086 361
Slovenia	2 007 711	273 464	41.5	0	273 655	2 009 117
Spain	40 525 002	5 864 419	41.1	0.1	5 906 780	40 817 729
Tunisia	10 383 577	2 413 484	29.2	1	2 660 713	11 447 236
Turkey	71 892 807	17 545 890	27.7	1.3	19 965 025	81 805 009
Mediter	458 445 552	107 403 812	33.2	0.9	121 526 405	507 693 365

Table 3 Prevalence of celiac disease in the next 10 years¹

	Estimated celiacs today	Estimated celiac children today at 1%	Projected prevalence of CD in next 10 yr	Projected celiac children in next 10 yr
Albania	36 198	8539	38 223	9017
Algeria	337 697	88 787	380 330	99 996
Bosnia	45 903	6738	47 483	6970
Cyprus	7926	1544	9372	1826
Croatia	44 915	7087	44 682	7050
Egypt	817 135	259 837	999 311	317 766
France	640 578	118 947	676 627	125 641
Greece	107 228	15 316	108 598	15 512
Israel	71 124	19 893	83 943	23 479
Italy	581 262	78 702	578 536	78 333
Lebanon	39 719	10 329	44 342	11 531
Libya	61 736	20 485	76 534	25 396
Malta	4035	661	4200	688
Morocco	343 432	104 735	383 098	116 831
Syria	197 476	71 466	240 864	87 168
Slovenia	20 077	2735	20 091	2737
Spain	405 250	58 644	408 177	59 068
Tunisia	103 836	24 135	114 472	26 607
Turkey	718 928	175 459	818 050	199 650
Mediter	4 584 456	1 074 038	5 076 934	1 215 264

¹Population prevalence estimated at minimum rate of 1%. CD: Celiac disease.

Table 4 Symptoms and diseases associated with symptomatic cases

	Symptomatic adults next 10 yr 1:7	Symptomatic children next 10 yr 1:5	Gastrointestinal symptoms	Anaemia	Osteopenia	Abnormal liver	Children with short stature
Albania	4172	1803	5079	2390	1793	598	361
Algeria	40 048	19 999	51 040	24 019	18 014	6005	4000
Bosnia	5788	1394	6104	2873	2154	718	279
Cyprus	1078	365	1227	577	433	144	73
Croatia	5376	1410	5768	2714	2036	679	282
Egypt	97 364	63 553	136 779	64 367	48 275	16 092	12 711
France	78 712	25 128	88 264	41 536	31 152	10 384	5026
Greece	13 298	3102	13 940	6560	4920	1640	620
Israel	8638	4696	11 333	5333	4000	1333	939
Italy	71 458	15 667	74 056	34 850	26 137	8712	3133
Lebanon	4687	2306	5944	2797	2098	699	461
Libya	7305	5079	10 527	4954	3715	1238	1016
Malta	502	138	543	256	192	64	28
Morocco	38 038	23 366	52 194	24 562	18 421	6140	4673
Syria	21 957	17 434	33 482	15 756	11 817	3939	3487
Slovenia	2479	547	2573	1211	908	303	109
Spain	49 873	11 814	52 433	24 675	18 506	6169	2363
Tunisia	12 552	5321	15 193	7149	5362	1787	1064
Turkey	88 343	39 930	109 032	51 309	38 482	12 827	7986
Mediter	551 667	243 053	675 512	317 888	238 416	79 472	48 611

Table 5 Excess cost of undiagnosed symptomatic celiac patients

	Purchasing power parity	Standardized cost for an adult in 6 yr of delay, €	Standardized cost for a child in 2 yr of delay, €	Total cost for adults in the next 10 yr, €	Total cost for children in the next 10 yr, €	Total cost of symptomatic in the next 10 yr, €
Albania	7.164	2804	821	11 698 575	1 481 020	13 179 595
Algeria	6.869	2688	787	107 662 164	15 748 296	123 410 460
Bosnia	7.361	2881	844	16 673 654	1 176 265	17 849 919
Cyprus	17.7	6928	2029	7 468 819	741 246	8 210 065
Croatia	28.54	11 171	3272	60 057 866	4 613 886	64 671 751
Egypt	6.123	2396	702	233 320 214	44 609 799	277 930 013
France	33.68	13 181	3861	1 037 513 563	97 017 277	1 134 530 840
Greece	29.88	11 695	3426	155 520 664	10 627 416	166 148 080
Israel	28.39	11 112	3255	95 985 202	15 284 247	111 269 450
Italy	29.11	11 393	3337	814 080 086	52 279 538	866 359 625
Lebanon	14.23	5568	1631	26 097 336	3 761 033	29 858 369
Libya	14.33	5608	1643	40 966 178	8 342 757	49 308 935
Malta	23.58	9230	2704	4 630 407	372 044	5 002 450
Morocco	4.604	1802	528	68 540 194	12 332 575	80 872 769
Syria	4.7	1839	539	40 388 186	9 393 156	49 781 342
Slovenia	29.69	11 619	3403	28 807 411	1 862 767	30 670 178
Spain	33.7	13 189	3863	657 786 976	45 639 366	703 426 342
Tunisia	8.254	3230	946	40 548 541	5 035 255	45 583 796
Turkey	12.48	4883	1430	431 358 582	57 108 945	488 467 527
Mediter	17.92	7012	2054	3 879 104 619	387 426 887	4 266 531 506

Table 6 Excess mortality in undiagnosed cases²

	Projected prevalence of CD in the next 10 yr	Death rate, deaths/1000 individuals	Population expected deaths (next 10 yr)	Celiac deaths in next 10 yr	Excess celiac deaths in next 10 yr
Albania	38 223	5.1	193 793	3488	1550
Algeria	380 330	4.6	1 764 730	31 765	14 118
Bosnia	47 483	8.6	409 780	7376	3278
Cyprus	9372	6.4	59 982	1080	480
Croatia	44 682	11.8	525 018	9450	4200
Egypt	999 311	4.9	4 876 635	87 779	39 013
France	676 627	8.6	5 791 930	104 255	46 335
Greece	108 598	10.5	1 141 363	20 545	9131
Israel	83 943	5.4	455 811	8205	3646
Italy	578 536	10.7	6 201 905	111 634	49 615
Lebanon	44 342	6	267 382	4813	2139
Libya	76 534	3.4	260 982	4698	2088
Malta	4200	8.4	35 193	633	282
Morocco	383 098	4.7	1 815 883	32 686	14 527
Syria	240 864	3.7	896 013	16 128	7168
Slovenia	20 091	9.2	184 839	3327	1479
Spain	408 177	10	4 077 691	73 398	32 622
Tunisia	114 472	5.2	595 256	10 715	4762
Turkey	818 050	6	4 908 301	88 349	39 266
Mediter	5 076 934	7	34 462 486	620 325	275 700

²Undiagnosed celiac patients have 1.8 standard mortality rate[39] . CD: Celiac disease.