1170 The Socioeconomic Impact on Presentation and Clinical Course of Celiac Disease

Abstract

INTRODUCTION: Treatment for Celiac Disease (CD) involves lifelong elimination of dietary gluten1. Compliance to a gluten-free diet (GFD) relies on purchasing gluten-free foods, which are commonly more expensive than their gluten-containing counterparts2. This study aimed to determine whether household income affects patients’ adherence to GFD and mucosal healing. METHODS: This is a single center retrospective chart review at an urban tertiary hospital. Any adult patient diagnosed with CD was included, with the exception of those without clear documentation of initial presentation. Outcomes included demographic information, socioeconomic data, GFD adherence, and pathologic and laboratory findings of CD. Using patient zip code, cohorts were stratified by US Census Bureau household income percentiles: low income (LI) (1st-50th percentile of US income), medium income (MI) (50th-70th percentile of US income) and high income (HI) (70th-99th percentile of US income). RESULTS: 193 patients diagnosed between 1999 – 2017 were included and categorized into LI (n = 49), MI (n = 95) and HI (n = 49). LI presented at an older age (39.8 yr in LI; 39.5 yr in MI; 38.4 yr in HI) with a higher proportion of patients with Marsh 3A or greater classification (68.8% in LI; 68.0% in MI; 57.7% in HI). Non-adherence to GFD was noted to be highest in LI (16.3% in LI; 4.7% in MI, 0.0% in HI). Subsequently, LI was found prolonged mucosal healing (79.2 mo. in LI; 44.3 mo. in MI; 33.5 mo. in HI). HI had the lowest percentage of patients with Marsh 3A or greater classification on repeat encounters (25.7% in LI; 36.6% in MI; 14.3% in HI). Normalization of TTG IgA (69.2% in LI; 72.0% in MI; 84.6% in HI) and gliadin IgA (20.0% in LI; 75.0% in MI; 85.7% in HI) occurred more frequently in HI. CONCLUSION: Discussion: GFD remains a staple in the management of CD. Our study sought to evaluate the impact of socioeconomic status on GFD adherence, severity of CD, and mucosal healing. The LI group was noted to be less adherent with GFD, have more severe disease presentation, have longer time to mucosal healing, and have less normalization of TTG IgA and gliadin IgA. Future studies may focus on further determining the causation between socioeconomic status, GFD adherence and CD outcomes.