Neighborhood Socioeconomic Deprivation Associates with Decreased Serologic Normalization Rates in Pediatric Celiac Disease.

Abstract

To characterize how neighborhood socioeconomic deprivation affects tissue transglutaminase (tTG) IgA normalization, a marker of effective gluten elimination. We conducted a single-center, retrospective cohort study of 207 children ≤18 years old with serology- or biopsy-based celiac disease diagnosed between 2013 and 2023. The primary exposure was the neighborhood deprivation index, a continuous measure (0-1) derived from the 2018 5-year American Community Survey. We categorized children from lowest to highest deprivation by quartiles (Q): Q1 (<0.15), Q2 (0.15-0.21), Q3 (0.21-0.29), or Q4 (>0.29). The primary outcome was tTG IgA normalization over the 60 months after seropositivity. We used Cox regression models to estimate hazard ratios (HRs) for tTG IgA normalization, adjusting for race, ethnicity, primary-spoken language, and insurance type in multivariable analyses. Of 207 children, the median deprivation index was 0.22 (IQR: 0.14, 0.29). Higher deprivation was associated with participants identifying as Black or Other race, Hispanic, non-English primary-speaking, and having public insurance. In univariate analysis, children in the highest quartile of neighborhood deprivation had a 50% lower normalization rate compared with those in the lowest quartile (HR 0.50; 95% confidence interval 0.27, 0.92; P = .03). In multivariable analysis, children in the highest quartile of neighborhood deprivation sustained a 67% lower normalization rate after adjusting for race, ethnicity, primary-spoken language, and insurance type (HR0.33; 95% confidence interval 0.15, 0.75; P = .008). Children living in socioeconomically deprived neighborhoods may have inadequate dietary adherence. Addressing the barriers to gluten elimination in deprived neighborhoods may improve outcomes.