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Celiac disease prevalence is stable; gluten free diets are not. And does contraception work? Spoiler… yes. This is Healthcare Triage News.

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Celiac disease prevalence is stable, gluten-free diets are not. And, does contraception work? Spoiler: yes. This is Healthcare Triage News.


From JAMA Internal Medicine, Time Trends in the Prevalence of Celiac Disease and Gluten-Free Diet in the US Population:
Results From the National Health and Nutrition Examination Surveys 2009-2014.

Researchers use NHANES to look at how many people who underwent serologic testing for celiac disease. They looked at how many of these people had prior diagnosis of celiac disease and were on a gluten-free diet.

They found 106 people who were confirmed as having a diagnosis of celiac disease and were adherent to a gluten-free diet. They found 213 people who did not have celiac disease and also were adherent to a gluten-free diet. These may sound like small numbers, but they represent 1.76 and 2.7 million people in the United States, respectively. 

From 2009 to 2014, the prevalence of celiac disease was stable, but the prevalence of a gluten-free diet was not. It went from 0.52% in 2009-10 to 0.99% in 2011-12 to 1.69% in 2013-14.

Of course, this is likely an underestimate of people eating a gluten-free diet, because some do it without being entirely adherent. And, many still go out of there way to avoid gluten for reasons that still elude me.

Our second story, from the Journal of Adolescent Health, Understanding the Decline in Adolescent Fertility in the United States, 2007–2013.

We've discussed many, many times on Healthcare Triage before how the teen pregnancy and birth rates are at all-time lows. But, why? Researchers set out to answer that.

They used data from the National Survey of Family Growth to calculate a "pregnancy risk index." The PRI calculates the risk of pregnancy based on sexual activity in the last month, contraceptive use, and contraceptive specific efficacy and failure rates. They calculated the PRI in 2007, 2009, and 2012.

They found that sexual activity didn't decline that much. What did change was contraceptive use. Use of the pill went from 26% to 35%, as did IUDs (1.3% to 2.7%), condoms (49 to 56%), and even withdrawal (15 to 20%). The use of multiple methods also increased from 23% to 34%. The percentage of kids reporting no contraceptive use dropped from 20% to 13%.

This led to the PRI dropping 5% every year from 2007 to 2012. Further, about 94% of the decline in the pregnancy risk index was attributable to contraceptive use. 

It's not that kids are having much less sex; it's that they're practicing much safer sex. This is good. Contraception works.


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