Racial disparities in relation to celiac disease in the United States

Who develops celiac disease (CD) 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, which 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.

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.

 

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

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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%).

While these results seem to indicate a lower likelihood of CD among African Americans, a commentary article (“Celiac Disease and the Forgotten 10%: the ‘Silent Minority’” https://pubmed.ncbi.nlm.nih.gov/25875755/) points out issues with this assumption:

 

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

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Another study similar to the previous listing, also 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.” (https://pubmed.ncbi.nlm.nih.gov/25665935)

 

 

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2012 study. “Gender and Racial Disparities in Duodenal Biopsy to Evaluate For Celiac Disease” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445758/

Gastroenterologists use endoscopies to look inside the small intestine; based on what they see, they may decide to take tissue samples for biopsy, which is the basis for a CD diagnosis.  Biopsies were less likely to be done on African Americans, so CD may have been missed.