Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 24, 2024; 15(8): 1048-1060
Published online Aug 24, 2024. doi: 10.5306/wjco.v15.i8.1048
Prevalence of malignant neoplasms in celiac disease patients - a nationwide United States population-based study
Maryam Bilal Haider, Ali Al Sbihi, Sushmitha Nanja Reddy, Peter Green
Maryam Bilal Haider, Department of Gastroenterology, Northshore University Health System, Evanston, IL 60201, United States
Ali Al Sbihi, Department of Hematology/Oncology, University of Miami Miller School of Medicine, Miami, FL 33101, United States
Sushmitha Nanja Reddy, Department of Hematology/Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI 48235, United States
Peter Green, Celiac Disease Center, Columbia University, New York, NY 10032, United States
Author contributions: Haider MB and Green P designed the research study; Haider MB performed the data collection, analysis, and interpretation of results; Haider MB, Al Sbihi A, and Reddy SN wrote the manuscript; Green P supervised the project; and all authors have read and approved the final manuscript.
Institutional review board statement: Information from this research utilized de-identified data sourced from the National Inpatient Sample Database, which is a publicly accessible database encompassing all-payer inpatient care information in the United States. There is no necessity for an Institutional Review Board Approval Form or Document.
Informed consent statement: The study utilized de-identified data from the National Inpatient Sample Database, which is a publicly accessible database containing information on all-payer inpatient care in the United States. Patient consent was not necessary for this analysis.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data that support the findings of this study are publicly available at https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maryam Bilal Haider, MD, Doctor, Department of Gastroenterology, Northshore University Health System, 2650 Ridge Ave, Evanston, IL 60201, United States. mhaider@northshore.org
Received: March 22, 2024
Revised: June 10, 2024
Accepted: June 27, 2024
Published online: August 24, 2024
Processing time: 146 Days and 19.1 Hours
Abstract
BACKGROUND

Celiac disease (CeD) is an autoimmune disorder triggered by the immune response to gluten in genetically predisposed individuals. Recent research has unveiled a heightened risk of developing specific malignant neoplasms (MN) and various malignancies, including gastrointestinal, lymphomas, skin, and others, in individuals with CeD.

AIM

To investigate the prevalence of MN in hospitalized CeD patients in the United States.

METHODS

Using data from the National Inpatient Sample spanning two decades, from January 2000 to December 2019, we identified 529842 CeD patients, of which 78128 (14.75%) had MN. Propensity score matching, based on age, sex, race, and calendar year, was employed to compare CeD patients with the general non-CeD population at a 1:1 ratio.

RESULTS

Positive associations were observed for several malignancies, including small intestine, lymphoma, nonmelanoma skin, liver, melanoma skin, pancreas myelodysplastic syndrome, biliary, stomach, and other neuroendocrine tumors (excluding small and large intestine malignant carcinoid), leukemia, uterus, and testis. Conversely, CeD patients exhibited a reduced risk of respiratory and secondary malignancies. Moreover, certain malignancies showed null associations with CeD, including head and neck, nervous system, esophagus, colorectal, anus, breast, malignant carcinoids, bone and connective tissues, myeloma, cervix, and ovary cancers.

CONCLUSION

Our study is unique in highlighting the detailed results of positive, negative, or null associations between different hematologic and solid malignancies and CeD. Furthermore, it offers insights into evolving trends in CeD hospital outcomes, shedding light on advancements in its management over the past two decades. These findings contribute valuable information to the understanding of CeD’s impact on health and healthcare utilization.

Keywords: Celiac disease; Malignant neoplasm; Autoimmune disorder; Hospitalized patients; Healthcare utilization; Gastrointestinal malignancies; Lymphomas; Epidemiology

Core Tip: This study from National Inpatient Sample database presents one of the largest studied cohort of celiac disease (CeD) and present significant insights into the association between CeD and various malignancies, including gastrointestinal, genitourinary, hematologic, and gynecologic cancers. Interestingly, CeD patients exhibit a reduced risk of respiratory malignancies. Variations in hospital outcomes, such as length of stay, cost of care, and inpatient mortality, highlight the complex relationship between CeD and malignancies. The study underscores the importance of recognizing this relationship, emphasizing the need for vigilant screening in CeD patients, particularly for specific malignancies like small intestine, lymphoma, and skin cancers. These findings contribute to refining CeD management and understanding broader healthcare trends over two decades.