Racial Disparities and Celiac Disease in the U.S.

Research on celiac disease (CD) reveals racial disparities in healthcare for African Americans. Based on the available data, the African American community in the U.S. needs more attention from the celiac community. This would include additional social support, improved medical attention, and additional research.

 

Celiac Disease in the U.S.

Who develops celiac disease and why? Three factors are involved:

1) a person must have the pre-disposing genes (~ 33% of the population have the genes, but only 1% develop CD);

2) a person must be consuming gluten; and

3) a person must experience some type of environmental triggering event or circumstance, that could include childhood antibiotic exposure, stressful events like surgery or pregnancy, make-up of the bacteria in the gut, and others factors (research is ongoing on factors which could be involved).

The existence of any of the 3 factors necessary for development of celiac disease could theoretically vary and be influenced by race/ethnicity.

Also relevant is the fact that among individuals with celiac disease, many (likely at least half) remain undiagnosed. The likelihood of being diagnosed (access to medical care, lack of referral bias, and other factors) could also be influenced by race/ethnicity.

 

Race and Celiac Disease

Following are summary points of some of the currently available relevant research.

 

These authors noted:  The low rate of diagnosis among African Americans could be due to referral bias (less likelihood of being referred to a specialist), or to socio-economic factors that affect access to health care.

 

Included 14,000 participants. Looked for positive serology (tTG and EMA antibodies) only; biopsies not involved. In this study, it was found that prevalence of CD autoimmunity was 4 times higher among non-Hispanic whites (1.08%) than in non-Hispanic blacks (.22%).

 

The tTG threshold levels could be lower in minorities, i.e. lower levels that were considered “normal” in this study could be indicative of CD in some minority individuals. Also, there are some cases of “sero-negative” CD, and these cases would have been missed. The “gold standard” of intestinal biopsy for diagnosing CD was not used.

Under-diagnosis in a certain group can occur if it is assumed that there is lower prevalence – a sort of vicious cycle. If CD is still considered to be a Caucasian disease (or mostly Caucasian), then it will be under-diagnosed among other groups because it is not looked for.

 

Racial Disparities in Celiac Disease

With regard to racial disparities in CD generally, this author also points out:

 

A similar study, published in 2015: Trends and Racial/Ethnic Disparities in Gluten-Sensitive Problems in the United States: Findings From the National Health and Nutrition Examination Surveys From 1988 to 2012.

 

A 2012 study, “Gender and Racial Disparities in Duodenal Biopsy to Evaluate For Celiac Disease” had more to say.

 

 

 

 

 

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