Background: Celiac disease (CeD) is mainly diagnosed in Caucasian populations, who are over-represented in clinical trials. It is unclear whether this reflects true prevalence differences or disparities in detection and representation. We compared engagement in an at-home CeD screening study using mailed versus electronic health record invitations in Latino/Hispanic and non-Hispanic patients served by a community health center.
Methods: We prospectively enrolled adults from selected zip codes seen at our institution. Invitation letters were mailed to Latino patients and age- and sex-matched non-Hispanic controls in their documented preferred language; bilingual electronic MyChart invitations were sent to a broader group from the same areas. Latino/Hispanic status was refined manually and with REthnicity (R package 2022). Interested participants completed an online questionnaire for eligibility and received a capillary blood collection kit for tTG IgA testing.
Results: Of 2,226 mailed letters, 903 Latino and 1,080 control recipients letters were not returned to sender. Engagement was comparable: 4.2% in the Latino group and 3.2% in controls (NS), with the highest among women aged 35–64 (5.0 and 6.5% respectively). MyChart invitations were sent to 11,458 individuals, including 6,991 identified as Latino. Fewer Latino patients had active accounts (14.2% vs 25.4% p<0.0001), but among recipients with active accounts, message acknowledgment (13.2% vs 15.1%) and interest (4.9% vs 4.3%) were similar. Interest was strongest among Latino women aged 35–64 (9.0%), while it was more evenly distributed in the controls, and lowest among Latinos under 35 (1.8%).
Conclusions: Bilingual mail and MyChart outreach for at-home screening for CeD produced similarly low engagement among Latino and non-Hispanic participants in an underserved community. Interest in CeD testing was greatest among Latino women aged 35–64, but MyChart messages failed to reach the majority of the target population.