title: The association between socioeconomic status and the symptoms at diagnosis of celiac disease: a retrospective cohort study.
abstract: BACKGROUND
  There are little data on patient factors that impact diagnosis rates of celiac disease. This study aims to evaluate the association between patient socioeconomic status and the symptoms at diagnosis of celiac disease.
  
  
  METHODS
  A total of 872 patients with biopsy-proven celiac disease were categorized based on the presence or absence of (1) diarrhea and (2) any gastrointestinal symptoms at diagnosis. Univariate and multivariate analyses were used to assess the association between socioeconomic status and symptoms.
  
  
  RESULTS
  Patients without diarrhea at presentation had a higher mean per capita income (US$34,469 versus US$32,237, p = 0.02), and patients without any gastrointestinal symptoms had a higher mean per capita income (US$36,738 versus US$31,758, p < 0.01) compared with patients having such symptoms. On multivariable analysis adjusting for sex, age, autoimmune or psychiatric comorbidities, and income, per capita income remained a significant predictor of diagnosis without gastrointestinal symptoms (odds ratio: 1.71, 95% confidence interval: 1.17-2.50, p < 0.01), and it showed a trend towards significance in diagnosis without diarrhea (odds ratio: 1.40, 95% confidence interval: 0.98-2.02, p = 0.06).
  
  
  CONCLUSIONS
  Patients with nonclassical symptoms of celiac disease are less likely to be diagnosed if they are of lower socioeconomic status. Celiac disease may be under-recognized in this population due to socioeconomic factors that possibly include lower rates of health-seeking behavior and access to healthcare.
authors.affiliation: Department of Gastroenterology, Columbia University, 622 West 168th Street, PH7 West (Room 318), New York, NY 10032, USA.
authors.forename: Abhik
authors.initials: A
authors.lastname: Roy
authors.affiliation: Division of Gastroenterology and Hepatology, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Mehra
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Ciarán P
authors.initials: CP
authors.lastname: Kelly
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Sohaib
authors.initials: S
authors.lastname: Tariq
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Kumar
authors.initials: K
authors.lastname: Pallav
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Dennis
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Peer
authors.affiliation: Department of Gastroenterology, Columbia University, New York, NY, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.affiliation: Department of Gastroenterology, Columbia University, New York, NY, USA.
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
keywords: diarrhea; gluten-free diet; healthcare disparity; income