Social Adversities Associate with Worse Disease Control in Pediatric Celiac Disease

Abstract

To characterize how social adversities influence disease control in children with celiac disease (CeD). We conducted a cross-sectional analysis of data from 325 eligible children ≤ 18 years old with CeD enrolled between 2015 through 2023 into iCureCeliac, a patient-centered US registry for CeD. We evaluated the associations between financial insecurity, social stigmatization, decreased health knowledge, and mental health comorbidity with two validated patient-reported outcomes on disease activity and gluten-free diet adherence: celiac symptom index and CeD adherence test, respectively. We used multivariable logistic and linear regression analysis to adjust for race, primary-spoken language, and socioeconomic status. Among 325 children with available financial insecurity data, the median age was 11 years (IQR 8, 15), 67% were female, and 88% were White. In multivariable logistic regression, the odds of elevated disease activity among children with financial insecurity, social stigmatization, decreased health knowledge, and mental health comorbidity were 2.6 (95% CI 0.9, 8.0; p=0.09), 2.8 (95% CI 1.6, 5.1; p<0.001), 4.8 (95% CI 2.4, 9.8; p<0.001), and 1.9 (95% CI 1.1, 3.3; p=0.03), respectively. For insufficient dietary adherence, the respective odds were 1.6 (95% CI 0.5, 4.7; p=0.43), 3.3 (95% CI 1.7, 6.5; p<0.001), 2.9 (95% CI 1.5, 5.7; p=0.002), and 2.3 (95% CI 1.2, 4.2; p=0.01). Statistically significant associations in logistic regression aligned with results of linear models. Social stigmatization, decreased health knowledge, and mental health comorbidity were associated with worse disease control in pediatric CeD. Targeted interventions aimed at addressing these social adversities may improve disease activity and dietary adherence.