Cheung Telly, McDonald Christine, Setty Mala, Tsai Patrika, Wadhwani Sharad I
Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
J Pediatr. 2025 Jan;276:114305. doi: 10.1016/j.jpeds.2024.114305. Epub 2024 Sep 16.
To characterize how social adversities influence disease control in children with celiac disease (CeD).
We conducted a cross-sectional analysis of data from 325 eligible children ≤18 years old with CeD enrolled between 2015 through 2023 into iCureCeliac, a patient-centered US registry for CeD. We evaluated the associations between financial insecurity, social stigmatization, decreased health knowledge, and mental health comorbidity with 2 validated patient-reported outcomes on disease activity and gluten-free diet adherence: celiac symptom index and CeD adherence test, respectively. We used multivariable logistic and linear regression analysis to adjust for race, primary spoken language, and socioeconomic status.
Among 325 children with available financial insecurity data, the median age was 11 years (IQR 8, 15), 67% were female, and 88% were White. In multivariable logistic regression, the odds of elevated disease activity among children with financial insecurity, social stigmatization, decreased health knowledge, and mental health comorbidity were 2.6 (95% CI 0.9, 8.0; P = .09), 2.8 (95% CI 1.6, 5.1; P < .001), 4.8 (95% CI 2.4, 9.8; P < .001), and 1.9 (95% CI 1.1, 3.3; P = .03), respectively. For insufficient dietary adherence, the respective odds were 1.6 (95% CI 0.5, 4.7; P = .43), 3.3 (95% CI 1.7, 6.5; P < .001), 2.9 (95% CI 1.5, 5.7; P = .002), and 2.3 (95% CI 1.2, 4.2; P = .01). Statistically significant associations in logistic regression aligned with results of linear models.
Social stigmatization, decreased health knowledge, and mental health comorbidity were associated with worse disease control in pediatric CeD. Targeted interventions aimed at addressing these social adversities may improve disease activity and dietary adherence.
描述社会逆境如何影响乳糜泻（CeD）患儿的疾病控制情况。
我们对2015年至2023年期间纳入以患者为中心的美国CeD登记系统iCureCeliac的325名年龄≤18岁的合格CeD患儿的数据进行了横断面分析。我们评估了经济不安全、社会污名化、健康知识减少和心理健康合并症与两项经过验证的患者报告的疾病活动和无麸质饮食依从性结果之间的关联：分别为乳糜泻症状指数和CeD依从性测试。我们使用多变量逻辑回归和线性回归分析来调整种族、主要语言和社会经济地位。
在325名有可用经济不安全数据的患儿中，中位年龄为11岁（四分位间距8，15），67%为女性，88%为白人。在多变量逻辑回归中，经济不安全、社会污名化、健康知识减少和心理健康合并症患儿疾病活动升高的比值分别为2.6（95%置信区间0.9，8.0；P = 0.09）、2.8（95%置信区间1.6，5.1；P < 0.001）、4.8（95%置信区间2.4，9.8；P < 0.001）和1.9（95%置信区间1.1，3.3；P = 0.03）。对于饮食依从性不足，相应的比值分别为1.6（95%置信区间0.5，4.7；P = 0.43）、3.3（95%置信区间1.7，6.5；P < 0.001）、2.9（95%置信区间1.5，5.7；P = 0.002）和2.3（95%置信区间1.2，4.2；P = 0.01）。逻辑回归中的统计学显著关联与线性模型的结果一致。
社会污名化、健康知识减少和心理健康合并症与儿科CeD中较差的疾病控制相关。旨在解决这些社会逆境的针对性干预措施可能会改善疾病活动和饮食依从性。
