Mortality, cardiovascular disease, and cancer in coeliac disease and dermatitis herpetiformis: a matched cohort study.

Abstract

Recent data on mortality risk in coeliac disease (CeD) have been contradictory. Large-scale research on mortality, cardiovascular disease (CVD), and cancer in dermatitis herpetiformis (DH) remains scarce. Using the U.S. TriNetX database we identified 204,056 adults with CeD and 6896 with DH between 2005 and 2025, and individually matched 1:1 with comparators without CeD or DH. Cox regression estimated hazard ratios (HRs) for mortality, CVD, and cancer, matching cohorts based on age, sex, nicotine dependence, and comorbidities. The mean age of patients with CeD and DH was 42.7 and 53.1 years, respectively, and females constituted 70.5% and 53.2%, respectively. Among patients with CeD, 8791/200551 (4.38%) died, compared with 7841/201285 (3.90%) matched comparators (adjusted (a)HR = 1.18; 95% CI = 1.14-1.22). Patients with CeD showed a modestly increased risk of a major adverse cardiovascular event (MACE, aHR = 1.11; 1.08-1.14). CeD was associated with an increased risk of haematological cancers (aHR = 1.42; 1.32-1.53), including non-Hodgkin lymphoma (aHR = 1.51; 1.35-1.68), but not with solid cancers (aHR = 1.00; 0.97-1.03). Among patients with DH, 566/6768 (8.36%) died, compared with 443/6770 (6.54%) matched comparators (aHR = 1.25; 1.10-1.42). DH was linked to MACE (aHR = 1.22; 1.08-1.37) and non-Hodgkin lymphoma (aHR = 2.58; 1.47-4.51). This U.S. population-based cohort study found that patients with CeD or DH had increased mortality risks compared with matched comparators. Both patient groups were also at increased risk of CVD, including MACE. Cancer associations showed different patterns in CeD and DH, with both exhibiting increased risks of non-Hodgkin lymphoma, with the highest risk observed in DH. Region Stockholm and Karolinska Institutet.