Risk of tuberculosis in a large sample of patients with coeliac disease - A nationwide cohort study
Résumé
Background Research suggests a positive association between coeliac disease (CD) and tuberculosis (TB), but that research has often been limited to inpatients and small sample size. We examined the relationship between TB and CD. Methods We collected biopsy data from all pathology departments in Sweden (n=28) to identify individuals who were diagnosed with CD between 1969 and 2007 (Marsh 3: villous atrophy; n=29,026 unique individuals). Population-based sex- and age-matched controls were selected from the Total Population Register. Using Cox regression, we calculated hazard ratios (HRs) for TB from data in the Swedish national health registers. Results Individuals with CD were at increased risk of TB (HR=2.0; 95% CI=1.3-3.0) (during follow-up, 31 individuals with CD and 74 reference individuals had a diagnosis of TB). The absolute risk of TB in patients with CD was 10/100,000 person-years with an excess risk of 5/100,000. Risk estimates were highest in the first year. Restricting our outcome to a diagnosis of TB confirmed by (I) a record of TB medication (HR=2.9; 95% CI=1.0-8.3), (II) data in the National Surveillance System for Infectious Diseases in Sweden (HR=2.6; 95% CI=1.3-5.2) or (III) positive TB cultivation (HR=3.3; 95% CI=1.6-6.8) increased risk estimates. The positive association between CD and TB was also observed before the CD diagnosis (odds ratio=1.6; 95% CI=1.2-2.1). Conclusions We found a moderately increased risk of TB in patients with CD.
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