Background
Disparities in celiac disease (CeD) recognition and testing have been reported across racial, ethnic, and socioeconomic groups. Emerging evidence suggests that differences in diagnosis may reflect healthcare access and screening practices rather than true disease prevalence. We evaluated whether social determinants of health (SDoH) and provider-related factors influenced CeD testing in children seen by pediatric gastroenterology providers.
Methods
Using electronic medical records from a large urban pediatric hospital, we identified new pediatric gastroenterology clinic visits for abdominal pain between 2021-2024. Patients with pre-existing CeD or inflammatory bowel disease were excluded. The primary outcome was ordering tissue transglutaminase immunoglobulin A (tTG-IgA) testing on the same day as the visit. Patient-level variables included race, ethnicity, and Medicaid insurance status. Provider characteristics included age, gender, visit format (telemedicine vs. in-person), and credentials (physician vs. nurse practitioner [NP]).
Results
Among 2,474 children (mean age 12 ± 4.6 years) identified, 61% were female, 44% Medicaid-insured, 40% White, 28% Hispanic, and 22% were Black. Celiac serology was ordered for 556 children (22.5%). Hispanic patients were more likely than non-Hispanic patients to get a CeD test (26.4% vs 21.0%, p=0.005). CeD testing rates did not differ between Black and non-Black patients (20.2% vs 21.7%, p=0.50). Medicaid participants were more likely to be screened than non-Medicaid patients (25.2% vs 20.4%, p=0.004). CeD testing was performed more often during in-person vs. telemedicine visits (26.1% vs 10.5%, p<0.001) and by NP providers vs. physicians (26.5% vs 21.3%, p=0.008).
Conclusions
Race was not independently associated with CeD testing. However, insurance type, visit modality, and provider type were significant predictors, suggesting that healthcare delivery factors may influence CeD screening practices.