# Poster Session I - A84 SOCIOECONOMIC FACTORS AND SYMPTOM BURDEN IN CELIAC DISEASE: RESULTS OF A NATIONWIDE CANADIAN SURVEY

## TL;DR

This Canadian survey found that socioeconomic and demographic factors are linked to higher symptom burden and slower recovery in celiac disease patients.

## Contribution

The study identifies specific demographic and socioeconomic factors associated with symptom severity and recovery in celiac disease patients.

## Key findings

- Females, racialized individuals, rural residents, and those with lower income or education reported more symptoms before diagnosis.
- Males were more likely to recover from symptoms like bloating and abdominal pain compared to females.
- Higher income and urban residency were associated with better recovery from various symptoms including brain fog and anxiety.

## Abstract

Prior surveys of those with celiac disease (CeD) in Canada have revealed changes in the most commonly experienced symptoms, with a growing recognition of extraintestinal manifestations of disease. Accordingly, it is worthwhile to understand if and how patient factors are associated with the severity and types of symptoms as well as their resolution after diagnosis.

Identify characteristics associated with greater symptoms among Canadians living with CeD.

An online survey was conducted in 2022, with information collected on domains such as demographics, symptoms, diagnosis, and management of the gluten-free diet (GFD). Cumulative link models were fit to estimate the association between respondent factors (gender, race/ethnicity, urban/rural status, income, education) with the number of symptoms experienced prior to diagnosis across three categories: gastrointestinal, extraintestinal, and psychological. Models were also fit for the likelihood of recovering from the three most common symptoms per category after initiation of the GFD. Models were adjusted for age, time since diagnosis, and comorbidities.

Among 7491 respondents, two-thirds (66%) reported being diagnosed by biopsy, with the remainder diagnosed by serology only or symptoms. Across all three symptom categories, there were increased odds of having more symptoms among females (F) compared to males (p < 0.001), whites compared to racialized persons (p < 0.05), rural settings (p < 0.001), lower income brackets (p < 0.001), and less than high school education compared to other education groups (p < 0.05). Males were more likely to recover from bloating (p < 0.001) and abdominal pain (p=0.040) than females, and an increasing likelihood of recovery for bloating, abdominal pain, and gas was associated with higher levels of income. Males were more likely than females to recover from weakness/tiredness (p = 0.002) and iron deficiency (p=0.002) than females as well as those living in urban areas or cities compared to those in rural areas (p<0.001). Similar trends were observed across income; there were no differences in likelihood of recovering from headaches/migraines between any respondent factor. Recovering from brain fog was higher in more urban areas (p=0.013); this increase was also observed as income levels increased (p<0.001). Males were more likely than females to recover from anxiety (p=0.009).

There is notable variation in the number of symptoms experienced across demographic and socioeconomic characteristics. Additionally, these patient-level factors may be associated with greater difficulties in symptom recovery; further efforts should focus on providing support for those at increased risk of symptom-related burden such as low-income individuals.

Celiac Canada