Age, Race, Ethnicity Disparities Hinder Celiac Disease Screening, with Debra Silberg, MD, PhD

A recent study presented at 2024 Annual North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Meeting in Hollywood, Florida, from November 7 to 9, 2024 identified low celiac disease screening and significant disparities by age group and race among patients aged ≤ 20 years.

Professional organizations recommend celiac disease screening for patients who present with specific symptoms and conditions. However, the differences in guideline adherence by age group, race, and presenting condition needed to be better understood. Investigators conducted a retrospective cohort analysis to investigate the celiac disease screening of children using payer claims data from 2007 to 2022.

Participants were recommended for celiac disease screening due to certain conditions, such as abdominal pain (recurrent), dental enamel defects, dermatitis herpetiformis, diarrhea (chronic), intestinal malabsorption (unspecified), and iron deficiency anemia. The presence of each condition, including celiac disease, was defined by condition-specific ICD-9 or 10-CM codes.

The findings revealed an inadequate adherence to celiac disease screening guidelines and screening disparities. Among 223,449 children recommended for celiac disease, only 10% were screened. Older patients (aged 11 – 20 years) were screened significantly more for celiac disease than younger children (aged 1 – 10 years) (13.5% vs 6.7%; P < .001).

At NASPGHAN, HCPLive spoke with investigator Debra Silberg, MD, PhD, from Beyond Celiac, who explained it can be harder to see what symptoms a younger child experiences.

“You can imagine that a 2-year-old can express a lot of things and also can often take time for malnutrition to occur,” Silberg said, “and that’s another reason to screen for celiac disease.

Additionally, significant screening differences existed across racial groups, with more Hispanic White children (12.2%) screened than children who were non-Hispanic Asian (9%), Hispanic (8%), unknown race (7.6%), and non-Hispanic Black (6.7%). Silberg said there is no reason why patients with different races or ethnicities should impact who gets screened for celiac disease despite the same presenting conditions.

Moreover, children with the presenting conditions of ataxia (8.7%; P < .001), oral aphthous ulcers (7.9%; P < .001), dental enamel defects (4.3%; P < .05), or iron deficiency (P < .05) have significantly fewer celiac disease screenings than those with other presenting conditions. Among these conditions, NASPGHAN recommends screening for those with dental enamel defects and iron deficiency that is resistant to oral iron.

The most common presenting condition among those screened was recurrent abdominal pain (63.4%), but despite this, the percentage of children presenting with recurrent abdominal pain who were screened for celiac disease was 13.6%.

Silberg said there is an issue with educating physicians on what presenting conditions they should look out for to guide their recommendations for a celiac disease screening. She also discussed the age, race, and ethnicity biases of healthcare providers when it comes to who can develop celiac disease.

“That's really something we're trying to put to the forefront and teach physicians that you shouldn't look at someone and decide that they can't have celiac disease just because of their race or ethnicity,” Silberg said. “You should think about all people, whether they could have a disease or not, and in this case, celiac disease.”

References

^{Miller, E, Avery, K, Ratner, A. Insufficient Adherence to Celiac Disease Screening Recommendations With Disparities By Race, Age, And Presenting Condition. Presented at NASPHGAN 2024 in Hollywood, Florida, from November 7 – November 9, 2024.}