Race and Ethnicity Disparities in Celiac Disease in the United States

Introduction: The prevalence of celiac disease (CeD) in the United States (US) population has increased in recent years. Traditionally, the disease was thought to affect predominantly non-Hispanic Whites with Northern European ancestry, but recent work has shown increasing prevalence among various racial groups. We aim to identify the race and ethnicity disparities of CeD-related symptoms and autoimmune conditions between Whites and Blacks with CeD. Methods: We conducted a retrospective cohort study using the TriNetX database, a multi-institutional database. The study included all adult patients aged 18 years or older diagnosed with CeD based on ICD-10 codes and CeD-related lab orders. We then generated 2 cohorts: Whites with CeD and Blacks with CeD. Date on symptoms, medical and comorbid conditions were gathered. We excluded patients with non-celiac gluten sensitivity (NCGS). We employed 1:1 propensity score matching for age and gender and performed multivariate analysis to assess for differences between the cohorts with respect to CeD-related symptoms and comorbidities. Results: After matching, we had 706 patients with CeD in each White and Black cohorts. Malaise was more common in Whites with CeD (OR 1.33, 95% CI 1.02-1.74, P=0.036), whereas constipation was less when compared to Blacks with CeD (OR 0.65, 95% CI 0.50-0.86, P=0.002). Whites also had higher odds of having dermatitis herpitiformis (OR 2.77, 95% CI 1.33-7.76, P=0.005), autoimmune thyroiditis (AIT; OR 1.99, 95% CI 1.12-3.55, P=0.017), and anxiety (OR 1.37, 95% CI 1.06-1.77, P=0.016), but lower odds having asthma (OR 0.71, 95% CI 0.53-0.96, P=0.03), epilepsy (OR 0.47, 95% CI 0.24-0.92, P=0.03), anemia of chronic disease (OR 0.34, 95% CI 0.17-0.67, P=0.001), and systematic lupus erythematous (SLE; OR 0.44, 95% CI 0.23-0.85, P=0.012) when compared with Blacks with CeD (Table 1). Conclusion: Significant differences in symptoms and comorbid conditions between Whites and Blacks were found in this large-scale nationwide study of CeD patients in the United States. Black patients with CeD exhibited a wide variety of presenting symptoms and autoimmune conditions; they had higher odds of nonclassical symptoms such as constipation. Further investigation is needed to determine if these clinical differences between Blacks and Whites lead to disparities in CeD diagnosis and management. Table 1. - A: Cohort Demographics After Propensity Score Matching. B: comparison of symptoms and comorbid conditions in race and ethnicity based-celiac disease patients (A) Cohort Demographics After Propensity Score Matching White with CeD (n=706) Black with CeD (n=706) Mean age ± SD 35.4 ± 21.8 35.4 ± 21.8 Sex Male 221 (31.3) 189 (26.8) Female 485 (68.7) 517 (73.2) Ethnicity Hispanic 22 (3.1) 24 (3.4) Non-Hispanic 598 (84.7) 550 (77.9) Unknown Ethnicity 86 (12.2) 132 (18.7) (B) OR 95% CI P-value Symptom Malaise 1.33 1.02-1.74 0.036 Constipation 0.65 0.50-0.86 0.002 Diarrhea 1.11 0.85-1.46 0.445 Comorbid Condition Dermatitis Herpetiformis 2.77 1.33-5.76 0.005 Autoimmune thyroiditis 1.99 1.12-3.56 0.017 Anxiety disorder 1.37 1.06-1.77 0.016 Asthma 0.71 0.53-0.96 0.027 Epilepsy 0.47 0.24-0.92 0.025 Systemic Lupus Erythematous 0.44 0.23-0.85 0.012 Values are n(%) or Mean ± SD. Odds ratio represents White CeD patients’ odds compared to Black CeD. Abbreviations: OR – odds ratio, CI – confidence interval, CeD – Celiac disease patients.