New Study Reveals Age and Racial Gaps in Pediatric Celiac Testing

Celiac.com 12/29/2025 - Celiac disease is a chronic immune condition that requires timely diagnosis to prevent long-term health problems. Medical guidelines recommend screening children who have symptoms or health conditions known to increase the likelihood of developing the disease. However, many children who should be screened are never tested. A recent study examined how often screening actually occurs in the United States, and whether factors like age or racial background influence the likelihood of receiving appropriate testing.

How the Study Was Conducted

The research team used a large private health insurance claims database covering the years 2007 through 2022. They evaluated more than two hundred twenty thousand children between the ages of one and twenty who had at least one condition indicating that they should be screened for celiac disease. None of these children had a prior diagnosis of the condition. The investigators reviewed whether each child had undergone a blood test designed to detect possible celiac disease, including tests for specific immune markers.

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The study population contained a wide range of ages and ethnic backgrounds. Slightly more than half of the children were between one and ten years old. A little more than half of the children were White, while the rest represented Hispanic, Black, Asian, or unknown racial groups. The most common health concerns among the children were repeated stomach pain, long-lasting diarrhea, and unexplained weight loss. These issues often lead doctors to consider celiac disease as a possible cause.

Overall Findings on Screening Rates

Despite all children in the study having at least one risk factor for the disease, only a small portion of them were tested. In fact, only about one out of ten children received any celiac disease blood test. Children who had a family member with the disease were the most likely to be screened. Those with type one diabetes or Turner syndrome were also more likely to be tested, perhaps due to greater awareness among healthcare providers. On the other hand, children with issues such as dental enamel defects, mouth ulcers, poor balance, or iron deficiency anemia were screened at very low rates, even though these conditions are known to be linked with celiac disease.

Impact of Racial and Ethnic Background

One of the most striking findings in the study was the difference in screening rates between children of different racial and ethnic groups. White children were screened at higher rates than children from minority groups. In most risk categories, including family history, type one diabetes, repeated stomach pain, and chronic diarrhea, children from racial or ethnic minority backgrounds were significantly less likely to be tested.

These differences persisted even after the researchers used statistical modeling to take into account other factors. For example, Black children had only about half the chance of being screened compared with White children, even when their risk conditions were the same.

Influence of Age on Screening

Younger children were also less likely to receive screening. Those younger than eleven years old were tested far less often than adolescents and older teens, even when they showed similar symptoms or risk conditions. This pattern was consistent across racial groups, suggesting that both age and racial background independently influence whether a child is properly screened.

How Symptoms Affected Screening Decisions

The study also explored how particular symptoms affected the likelihood of screening. Children who had both chronic diarrhea and repeated stomach pain were more likely to be tested for celiac disease than those who had stomach pain alone. However, children who had only chronic diarrhea were less likely to be screened than children who had neither symptom. These mixed results show that screening decisions may depend heavily on how doctors interpret combinations of symptoms, rather than following a simple guideline.

Limitations of the Research

The authors of the study noted several limitations. The data did not allow the team to analyze whether screening practices improved or worsened over the fifteen-year period. The study relied on diagnosis codes used in insurance systems, which do not always capture the full details of a child's medical situation. In addition, the database included only children with private health insurance, so the results might not reflect what happens among children with public insurance or no insurance. Finally, very few children in the data set had actual test results available, preventing the researchers from examining how many children ultimately tested positive for the condition.

What the Results Mean

The study reveals meaningful gaps in how medical guidelines for celiac disease screening are applied in real-world settings. Children who are younger and children from racial and ethnic minority backgrounds are being tested far less often than their White or older peers, even when they share the same risk factors. This means many children who may have celiac disease are being missed, which can delay diagnosis and treatment.

Why This Matters for Families Affected by Celiac Disease

For people who care about celiac disease, especially families who have children at higher risk, the findings highlight the importance of self-advocacy. Because early detection can prevent serious long-term health issues, parents may need to ask their healthcare providers directly about screening when their children have risk factors. The study also supports the need for improved education for medical professionals so that screening recommendations are followed more consistently. Greater awareness could help reduce disparities and ensure that all children, regardless of age or background, receive the testing they need.

Read more at: gastroenterologyadvisor.com