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  • Jefferson Adams
    Jefferson Adams

    Do Income Levels Influence Celiac Disease Diagnosis?

    Reviewed and edited by a celiac disease expert.

    Caption: Photo: CC-lalunablanca

    Celiac.com 05/30/2011 - Income plays a major role in whether patients with uncommon symptoms of celiac disease are accurately diagnosed, according to a new study from the Beth Israel Deaconess Medical Center in Boston.

    A team of researchers led by Daniel Leffler, MD, compared data of nearly 800 adult patients with celiac disease based on presenting symptoms and household and per capita earnings.

    Some patients had complained of acute gastrointestinal distress, while others complained of classic celiac disease signs like weight loss and anemia, and others of less typical issues.

    Regardless of patient symptoms upon complaint, the research team found "a very striking linear correlation" between levels of diagnosis and in higher versus lower income groups.

    Basically, people with better socioeconomic status, had better chances of being diagnosed, according to Dr. Leffler, director of clinical research at the hospital's celiac center.

    The income disparity may reflect differences in both health awareness and access to health information between higher and lower income groups. The difference serves as a "marker for patients having the resources to educate themselves as to what might be the underlying cause of their disorder," Dr. Leffler said. "Celiac testing is often prompted by patient request rather than physician suspicion, which almost certainly contributes to the diagnostic disparity seen in this study."

    He believes the study shows a need for greater awareness among both physicians and the public.

    "Although we need physicians to be more proactive in celiac testing, we can't just focus on physician training if we want to make a difference," he said. "There are likely significant gains to also be made in patient education."

    Dr. Leffler's findings were included as part of presentations for Digestive Disease Week (DDW), the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

    DDW is sponsored jointly by the American Association for the Study of Liver Diseases, the AGA Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract.

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    Only the rich can afford the the cost of foods (never-mind the cost of the biopsy) one must eat if celiac and if they have a pre-existing condition (like type 1 Diabetes) it's even worse!

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    Only the rich can afford the the cost of foods (never-mind the cost of the biopsy) one must eat if celiac and if they have a pre-existing condition (like type 1 Diabetes) it's even worse!

    Well said Anne! It's outrageous what people with celiacs have to pay for food. I was also recently diagnosed with diabetes and combining the 2 diets together is costing me a fortune. I am disabled and on a fixed income. When is someone going to do something about these prices?

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    Interesting that Dr. Leffler's conclusion pushed the impetus back onto the patient, rather than looking at differences in the quality of health care available to people at different income levels, and what might be done about that. I am weary of doctors that conclude patient education as the solution to health care issues. If we wanted to be doctors and had the aptitude, we would have gone to med school. Most of us didn't. And we don't like having to get our own, late night, ad hoc medical education researching our symptoms by ourselves. Some of us have the research skills and access to the materials necessary to self-diagnose our own medical conditions, but the vast majority of people don't. Certainly, most people in the lower income levels have neither the education level nor the access to materials necessary to do so. That is why they rely on medical professionals.


    The fact is most people at the lowest income strata, when they receive health care at all, receive it via public health clinics, public hospitals, and emergency rooms. While retraining private physicians to properly diagnose Celiac Disease may be a tough, long-term battle, the federal government could be motivated to create an initiative to address this through public health programs. This would have the double benefit of getting more people properly diagnosed, and reducing publicly-funded health care costs.


    More thought should be given to critiquing the results of studies such as this, rather than simply recounting the conclusions of the studies. The full citation of the published study or the conference at which it was presented should be provided so the reader can follow up with it directly.

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    Guest rogene robbins


    Interesting article but I think there is another factor even more basic than patient awareness. People with good insurance get diagnostic tests. Doctors are much less willing to order a lot of tests for people with no or inadequate insurance coverage which unfortunately here in the US is more likely in lower income groups.

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    I think the income is completely overrated. People who tend to be in the lower income bracket also tend to not participate in any preventative measures provided for free. This has been studied and concluded. Health problems in lower income areas are often issues that come from a lifestyle and not from genetics. Making it available doesn't always mean people will take advantage of it.


    Besides health screening and medicine, self-educating is available to anyone. Information about being healthy and prevention is available in numerous websites. Everyone is responsible for their own health. A doctor is only a last step. I learned of my gluten allergy by reading and trying different diets before I found one that helped.


    This article speaks too generally. Jefferson Adams discusses a single research result without discussing the full story behind it. I will be cautious of this writer in the future. We are too quick to pin a simple answer on a much deeper one. Adams does this here when he concludes that low income results in more people undiagnosed. We need to look at all the facts.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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