Prevalence of malignant neoplasms in celiac disease patients - a nationwide United States population-based study

Table 1 Comparison between patient’s characteristics of celiac disease patients with and without malignant neoplasms, National Inpatient Sample 2000-2019

	Overall CeD patients	CeD without MN, weighted, n (%)	CeD with MN, weighted, n (%)	P value
Weighted total	529842	451714 (85.25)	78128 (14.75)
Sex				< 0.00012
Female	374102 (70.61)	323904 (71.70)	50199 (64.25)
Male	155739 (29.39)	127810 (28.30)	27929 (35.75)
Age (year), mean ± SD	55.34 ± 22.17	53.08 ± 22.40	67.66 ± 15.94	< 0.00011
Age groups (year)				< 0.00013
< 18	30807 (5.82)	29910 (6.62)	898 (1.15)
18-49	168411 (31.79)	159531 (35.31)	8880 (11.35)
49-59	75661 (14.28)	65080 (14.42)	10581 (13.54)
59-69	85753 (16.18)	68589 (15.18)	17164 (21.96)
≥ 70	169209 (31.93)	128604 (28.47)	40605 (51.97)
Race/ethnicity				< 0.00013
White	421882 (79.64)	356333 (78.88)	65549 (83.90)
Black	14876 (2.81)	13386 (2.96)	1490 (1.90)
Hispanic	20834 (3.93)	18657 (4.13)	2177 (2.78)
Asian or Pacific Islander	2746 (0.51)	2462 (0.55)	284 (0.36)
Native American	1698 (0.32)	1501 (0.33)	197 (0.25)
Other	67806 (12.79)	59375 (13.14)	8431 (10.79)
Median household income for patient’s zip code				< 0.00013
0-25th percentile	91079 (17.19)	79152 (17.52)	11927 (15.26)
26th to 50th percentile (median)	125043 (23.60)	107046 (23.70)	17997 (23.05)
51st to 75th percentile	143974 (27.17)	122501 (27.12)	21472 (27.48)
76th to 100th percentile	160727 (30.34)	135206 (29.93)	25521 (32.66)
Other	9019 (1.70)	7807 (1.73)	1211 (1.55)

¹Two sample Student t-test, 2-tailed for comparing means of two continuous variables.

²Rao-Scott χ², 2-tailed test for the association of two categorical variables.

³Rao-Scott χ², 2-tailed test for two by n table. Statistical significance illustrates that the two groups differ.

CeD: Celiac disease; MN: Malignant neoplasm.

Table 2 Prevalence of malignant neoplasms in celiac disease vs matched (age-, sex-, race) non-celiac disease patients, National Inpatient Sample 2000-2019

Neoplasm type	CeD cases	CeD controls	OR (95%CI)	P value
	Unweighted (n = 108052), 50%, n (%)	Unweighted (n = 108052), 50%, n (%)
All malignant neoplasm	15884 (14.70)	14125 (13.07)	1.15 (1.12-1.18)	< 0.0001
Positive association
Stomach	179 (0.17)	133 (0.12)	1.35 (1.08-1.69)	0.0092
Small intestine	177 (0.16)	23 (0.02)	7.71 (5.0-11.9)	< 0.0001
Liver	261 (0.24)	143 (0.13)	1.83 (1.49-2.24)	< 0.0001
Biliary	90 (0.08)	65 (0.06)	1.39 (1.01-1.91)	0.0446
Other GI organs	87 (0.08)	43 (0.04)	2.02 (1.41-2.92)	< 0.0001
Thyroid	474 (0.44)	259 (0.24)	1.84 (1.58-2.13)	< 0.0001
Pancreas	358 (0.33)	235 (0.22)	1.53 (1.29-1.80)	< 0.0001
Melanoma skin	552 (0.51)	359 (0.33)	1.54 (1.35-1.76)	< 0.0001
Nonmelanoma skin (all other skin excluding melanoma)	1441 (1.33)	735 (0.68)	1.97 (1.81-2.16)	< 0.0001
Other neuroendocrine tumors	74 (0.07)	50 (0.05)	1.48 (1.03-2.12)	0.0311
Lymphoma	1861 (1.72)	912 (0.84)	2.06 (1.90-2.23)	< 0.0001
Leukemia	835 (0.77)	742 (0.69)	1.13 (1.02-1.25)	0.0187
Myelodysplastic syndrome	397 (0.37)	216 (0.20)	1.84 (1.55-2.17)	< 0.0001
Uterus	562 (0.52)	482 (0.45)	1.17 (1.03-1.32)	0.0131
Prostate	1421 (1.32)	1247 (1.15)	1.14 (1.06-1.23)	0.0007
Testis	84 (0.08)	56 (0.05)	1.50 (1.07-2.10)	0.0179
Negative association
Respiratory	1244 (1.15)	1813 (1.68)	0.68 (0.63-0.73)	< 0.0001
Secondary malignancies	2199 (2.04)	2846 (2.63)	0.76 (0.73-0.81)	< 0.0001
Urinary	952 (0.88)	1053 (0.97)	0.90 (0.83-0.99)	0.0234
Null association
Head and neck	272 (0.25)	314 (0.29)	0.87 (0.74-1.02)	0.0823
Nervous system	227 (0.21)	257 (0.24)	0.88 (0.74-1.06)	0.1722
Esophagus	152 (0.14)	125 (0.12)	1.22 (0.96-1.54)	0.1045
Colorectal	1752 (1.62)	1774 (1.64)	0.99 (0.93-1.06)	0.7087
Anus	21 (0.02)	26 (0.02)	0.81 (0.45-1.44)	0.4658
Breast	2844 (2.63)	2919 (2.70)	0.98 (0.92-1.03)	0.3166
Other endocrine (excluding thyroid and pancreas)	25 (0.02)	30 (0.03)	0.83 (0.49-1.41)	0.5001
Malignant carcinoid tumor - small intestine	14 (0.01)	13 (0.01)	1.08 (0.51-2.29)	0.8474
Malignant carcinoid tumor - large intestine	5 (0.005)	6 (0.005)	0.83 (0.25-2.73)	0.7630
Bone and connective tissues	134 (0.12)	161 (0.15)	0.83 (0.66-1.04)	0.1157
Myeloma	313 (0.29)	274 (0.25)	1.14 (0.97-1.34)	0.1070
Cervix	448 (0.41)	418 (0.39)	1.07 (0.94-1.22)	0.3070
Ovary	472 (0.44)	430 (0.40)	1.10 (0.96-1.25)	0.1611
Other female genital organs	126 (0.12)	139 (0.13)	0.91 (0.71-1.15)	0.4242
Other male genital organs	11 (0.01)	4 (0.004)	2.75 (0.88-8.63)	0.0707

CeD: Celiac disease; OR: Odds ratio; CI: Confidence interval; GI: Gastrointestinal.

Table 3 Comparison of inpatient mortality, mean total charges, and length of stay in celiac disease patients with malignant neoplasms vs matched non-celiac disease with malignant neoplasm (matched by age-, sex-, race-, and malignant neoplasm profile), National Inpatient Sample 2000-2019

	Mortality		Length of stay		Total charges
	OR (99%CI)	P value	Mean difference (99%CI)	P value	Mean (99%CI)	P value
CeD with MN	0.72 (0.61-0.86)	< 0.00011	0.21 (0.05-0.38)	0.00062	$3172, $1467-$4878	< 0.00012
Matched non-CeD with MN	Reference	NA	Reference	NA	Reference	NA

¹χ², 2-tailed test for the association of two categorical variables.

²Two sample Student t-test, 2-tailed for comparing means of two continuous variables.

CeD: Celiac disease; MN: Malignant neoplasm; OR: Odds ratio; CI: Confidence interval; NA: Not available.