DISTANCE FROM HEALTH CARE FACILITY AND OTHER VARIABLES IMPACT TIME TO CELIAC DISEASE DIAGNOSIS
Author(s)
Erin B. Miller, MPH, Kate T. Avery, MPH, Debra G. Silberg, MD, PhD;
Beyond Celiac, Ambler, PA, USA
Beyond Celiac, Ambler, PA, USA
OBJECTIVES: The current favored strategy to increase celiac disease (CD) detection is active case finding among patients with related conditions. We sought to understand whether the diagnostic interval is uniform across patients with differing demographic characteristics and geographic access.
METHODS: We conducted a survey of individuals ages 13+ with a CD diagnosis and at least one of 25 related conditions (e.g., iron deficiency anemia) diagnosed prior to CD. Participants reported age at CD diagnosis and at related conditions, and demographics were collected. Time to CD diagnosis was defined as the difference between age at first-reported related diagnosis and at CD diagnosis. Participants also reported ZIP codes for both primary residence at the time of CD diagnosis and the diagnosing location. Using ZIP code centroids, the shortest straight-line distance between locations was calculated.
RESULTS: 551 participants completed the survey. Most were female (87.1%) and working full-time (59.3%). Some had state or federal marketplace insurance (5.6%). The average straight-line distance was 14.4 miles (SD = 115.7, 95% CI [4.7, 24.1]).
Greater distance traveled for diagnosis was associated with longer time to CD diagnosis (p = .0166, rho = .102). Gender was also associated (p = .0303, f = .172), with women experiencing longer times than men. Employment status was associated with diagnostic interval length (p < .00001, f = .263), with students experiencing shorter times to diagnosis compared with individuals working full-time, working part-time, stay-at-home parents, or retired (all p = .0010). Individuals with marketplace insurance experienced shorter times to diagnosis compared with those with other insurance types (p = .0146, d = .430).
CONCLUSIONS: The interval between related condition diagnosis and CD diagnosis varies by geographic access and demographic characteristics. These findings suggest that active case-finding strategies may be less effective for certain populations, underscoring the need for additional approaches to promote timely CD detection.
METHODS: We conducted a survey of individuals ages 13+ with a CD diagnosis and at least one of 25 related conditions (e.g., iron deficiency anemia) diagnosed prior to CD. Participants reported age at CD diagnosis and at related conditions, and demographics were collected. Time to CD diagnosis was defined as the difference between age at first-reported related diagnosis and at CD diagnosis. Participants also reported ZIP codes for both primary residence at the time of CD diagnosis and the diagnosing location. Using ZIP code centroids, the shortest straight-line distance between locations was calculated.
RESULTS: 551 participants completed the survey. Most were female (87.1%) and working full-time (59.3%). Some had state or federal marketplace insurance (5.6%). The average straight-line distance was 14.4 miles (SD = 115.7, 95% CI [4.7, 24.1]).
Greater distance traveled for diagnosis was associated with longer time to CD diagnosis (p = .0166, rho = .102). Gender was also associated (p = .0303, f = .172), with women experiencing longer times than men. Employment status was associated with diagnostic interval length (p < .00001, f = .263), with students experiencing shorter times to diagnosis compared with individuals working full-time, working part-time, stay-at-home parents, or retired (all p = .0010). Individuals with marketplace insurance experienced shorter times to diagnosis compared with those with other insurance types (p = .0146, d = .430).
CONCLUSIONS: The interval between related condition diagnosis and CD diagnosis varies by geographic access and demographic characteristics. These findings suggest that active case-finding strategies may be less effective for certain populations, underscoring the need for additional approaches to promote timely CD detection.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD81
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Gastrointestinal Disorders