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Tuberculosis
Coeliac disease and risk of tuberculosis: a population based cohort study
  1. J F Ludvigsson1,2,
  2. J Wahlstrom3,
  3. J Grunewald3,
  4. A Ekbom2,4,
  5. S M Montgomery2,5
  1. 1Department of Paediatrics, Örebro University Hospital, Sweden
  2. 2Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital/Institute, Sweden
  3. 3Division of Respiratory Medicine, Department of Medicine, Karolinska University Hospital/Institute, Sweden
  4. 4Harvard Medical School, Boston, Massachusetts, USA
  5. 5Clinical Research Centre, Örebro University Hospital, Sweden
  1. Correspondence to:
    Dr J F Ludvigsson
    Department of Paediatrics, Örebro University Hospital, Sweden; jonasludvigsson{at}yahoo.com

Abstract

Background: Coeliac disease (CD) is an autoimmune disease often characterised by malnutrition and linked to a number of complications such as an increased risk of lymphoma, adverse pregnancy outcome, and other autoimmune diseases. Tuberculosis (TB) affects a large proportion of the world population and is more common in individuals with malnutrition. We investigated the risk of TB in 14 335 individuals with CD and 69 888 matched reference individuals in a general population based cohort study.

Methods: Cox proportional hazards method was used to calculate the risk of subsequent TB in individuals with CD. In a separate analysis, the risk of CD in individuals with prior TB was calculated using conditional logistic regression.

Results: CD was associated with an increased risk of subsequent TB (hazard ratio (HR) 3.74, 95% CI 2.14 to 6.53; p<0.001). Similar risk estimates were seen when the population was stratified for sex and age at CD diagnosis. Individuals with CD were also at increased risk of TB diagnosed in departments of pulmonary medicine, infectious diseases, paediatrics, or thoracic medicine (HR 4.76, 95% CI 2.23 to 10.16; p<0.001). The odds ratio for CD in individuals with prior TB was 2.50 (95% CI 1.75 to 3.55; p<0.001).

Conclusions: CD is associated with TB. This may be due to malabsorption and lack of vitamin D in persons with CD. Individuals with TB and gastrointestinal symptoms should be investigated for CD.

  • CD, coeliac disease
  • IFN, interferon
  • SEI, socioeconomic index
  • TB, tuberculosis
  • autoimmunity
  • coeliac disease
  • cohort study
  • tuberculosis

https://doi.org/10.1136/thx.2006.059451

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    Footnotes

    • This project was supported by a grant from The Swedish Society of Medicine, the Swedish Research Council, the Sven Jerring Foundation, the Örebro Society of Medicine, the Majblomman Foundation, and the Swedish Coeliac Society. JW and JG were sponsored by the Swedish Heart Lung Foundation, and JG by the Swedish Research Council. JFL was sponsored by the Juhlin Foundation, the Clas Groschinsky Foundation, and was supported by a grant from the Örebro University Hospital while writing this article.

    • Competing interests: none declared.

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