Poster Presentation International Celiac Disease Symposium 2026

Does Patient Race Influence Consideration of Celiac Disease in Primary Care? A Randomized Vignette-Based Study of Pediatric Providers (#330)

Catherine Raber 1 2 , Shayna S Coburn 1 3 , Geraldine M Mendez-Gonzalez 4 , Paige J Trojanowski 1 5 , Evan V Bianchi 1 , Jack A Vagadori 6 , Abriana C Cain 2 , Lori L Stern 2 , Vahe Badalyan 2 3
  1. Center for Health Outcomes Research and Delivery Science, Children's National Hospital, Washington, DC, United States
  2. Division of Gastroenterology, Hepatology and Nutrition, Children's National Hospital, Washington, DC, United States
  3. School of Medicine and Health Sciences, George Washington University, Washington, DC, United States
  4. Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
  5. Primary Care Mental Health, Children's National Hospital, Washington, DC, United States
  6. Child Health and Medical Pain Lab, Georgia State University, Atlanta, GA, United States

 

Background

Despite recognition that celiac disease (CeD) affects individuals across all racial and ethnic groups, diagnostic disparities persist. Limited awareness of CeD epidemiology may contribute to differences in screening and diagnosis. We evaluated whether patient race or provider characteristics influence clinicians' consideration of CeD in a controlled clinical scenario.

 

Methods

We conducted a randomized survey of primary pediatric healthcare providers in the Washington, DC metropolitan region. Participants randomly received one of two clinical vignettes describing a child with CeD-compatible symptoms, varying only the child’s race (Black versus White). Providers self-reported sociodemographics (e.g. race, ethnicity, gender, credentials), years practicing, and estimated Medicaid population served. They described their differential diagnoses in free-text responses, which were dummy-coded for CeD screening. Univariate logistic regression was used to assess association of provider and patient characteristics with CeD screening.

 

Results

Among 106 respondents, most practiced in Maryland (52.8%) or Washington, DC (39.6%), were female (84.9%), physicians (84.0%), and had completed training more than five years prior (72.6%). Overall, 84.9% included CeD in their differential diagnosis. Providers receiving the White-child vignette considered CeD more frequently than those receiving the Black-child vignette (90.7% vs 78.8%); however, this difference was not statistically significant. CeD consideration was not associated with provider type, practice location, gender, age, or years in practice. White providers were more likely than non-White providers to consider CeD screening (89.7% vs 71.9%, p=0.023).

 

Conclusions

Most providers considered CeD screening, yet 15.1% did not immediately consider it. This pilot study did not detect significant differences based on patient race, but trends in favor of White children being screened more frequently raise concerns. Provider race may also need to be considered as possible targets for building awareness in medical education.  Larger studies are needed to identify factors contributing to persistent disparities in CeD diagnosis.