Gaps and Disparities in Celiac Disease Screening: A Nationwide Analysis of a High-Risk Pediatric Population

Despite established screening guidelines for celiac disease (CeD) targeting high-risk groups, many people remain undiagnosed, leading to potential long-term health consequences. The aim of this study was to evaluate adherence to CeD screening guidelines among children with high-risk conditions.

We performed a retrospective cohort analysis utilizing United States (US) private payer claims data from 2007 to 2022 to identify children ≤ 20 years who met screening criteria for CeD. All children had at least one high-risk condition recommended for CeD screening by professional organizations. Those with a history of CeD were excluded. We used descriptive statistics and chi-square tests to assess the presence of CeD screening by age group, race, and condition to determine the value of screening results by race. Logistic regression models were used to identify factors associated with CeD screening.

Among 223,449 children with high-risk conditions, only 10.0% were screened. Patients with a family history of CeD had the highest likelihood of being screened (55.49%). Non-White children were screened less frequently than White children (p < .0001), which held true when stratifying by most screening conditions. Children aged < 11 years were screened less frequently than their older peers (p < .0001). In a multivariable model, age and racial disparities in screening persisted.

Our findings highlight significant gaps in adherence to CeD screening guidelines, particularly among younger and Non-White children, underscoring the need for improved awareness and implementation of screening practices.