Socioeconomic status may contribute to celiac diagnostic disparity

Health outcomes explored at DDW 2011

Income is a pivotal factor in whether a patient without common symptoms of celiac disease is accurately diagnosed with the digestive condition, according to a new study from the Beth Israel Deaconess Medical Center in Boston, MA.

Daniel Leffler, MD, and colleagues divided the cases of nearly 800 adult patients with celiac disease based on presenting symptoms and household and per capita earnings. Some patients had complained of acute gastrointestinal distress, others of such classic celiac disease signs as weight loss and anemia, and others of still additional problems. Regardless, the researchers' analysis found the same pattern: "a very striking linear correlation" pegged to higher versus lower income.

"The better your socioeconomic status, the better your chances of being diagnosed," said Dr. Leffler, director of clinical research at the hospital's celiac center.

The income gap may reflect a gap in health literacy and access to health information between socioeconomic brackets. "It is a marker for patients having the resources to educate themselves as to what might be the underlying cause of their disorder," Dr. Leffler said. "Celiac testing is often prompted by patient request rather than physician suspicion, which almost certainly contributes to the diagnostic disparity seen in this study."

He believes the study underscores the need for much more awareness among physicians as well as the public.

"Although we need physicians to be more proactive in celiac testing, we can't just focus on physician training if we want to make a difference," he said. "There are likely significant gains to also be made in patient education."