Telly Cheung MD , Mala Setty MD , Cynthia Fenton MD , Christine M. McDonald ScD, MS , Patrika Tsai MD, MPH , Jennifer C. Lai MD, MBA , Sharad I. Wadhwani MD, MPH
{"title":"邻里社会经济剥夺与儿童乳糜泻血清学正常化率降低有关。","authors":"Telly Cheung MD , Mala Setty MD , Cynthia Fenton MD , Christine M. McDonald ScD, MS , Patrika Tsai MD, MPH , Jennifer C. Lai MD, MBA , Sharad I. Wadhwani MD, MPH","doi":"10.1016/j.jpeds.2025.114717","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To characterize how neighborhood socioeconomic deprivation affects tissue transglutaminase (tTG) IgA normalization, a marker of effective gluten elimination.</div></div><div><h3>Study design</h3><div>We conducted a single-center, retrospective cohort study of 207 children ≤18 years old with serology- or biopsy-based celiac disease diagnosed between 2013 and 2023. The primary exposure was the neighborhood deprivation index, a continuous measure (0-1) derived from the 2018 5-year American Community Survey. We categorized children from lowest to highest deprivation by quartiles (Q): Q1 (<0.15), Q2 (0.15-0.21), Q3 (0.21-0.29), or Q4 (>0.29). The primary outcome was tTG IgA normalization over the 60 months after seropositivity. We used Cox regression models to estimate hazard ratios (HRs) for tTG IgA normalization, adjusting for race, ethnicity, primary-spoken language, and insurance type in multivariable analyses.</div></div><div><h3>Results</h3><div>Of 207 children, the median deprivation index was 0.22 (IQR: 0.14, 0.29). Higher deprivation was associated with participants identifying as Black or Other race, Hispanic, non-English primary-speaking, and having public insurance. In univariate analysis, children in the highest quartile of neighborhood deprivation had a 50% lower normalization rate compared with those in the lowest quartile (HR 0.50; 95% confidence interval 0.27, 0.92; <em>P</em> = .03). In multivariable analysis, children in the highest quartile of neighborhood deprivation sustained a 67% lower normalization rate after adjusting for race, ethnicity, primary-spoken language, and insurance type (HR0.33; 95% confidence interval 0.15, 0.75; <em>P</em> = .008).</div></div><div><h3>Conclusions</h3><div>Children living in socioeconomically deprived neighborhoods may have inadequate dietary adherence. Addressing the barriers to gluten elimination in deprived neighborhoods may improve outcomes.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"286 ","pages":"Article 114717"},"PeriodicalIF":3.5000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Neighborhood Socioeconomic Deprivation Associates with Decreased Serologic Normalization Rates in Pediatric Celiac Disease\",\"authors\":\"Telly Cheung MD , Mala Setty MD , Cynthia Fenton MD , Christine M. McDonald ScD, MS , Patrika Tsai MD, MPH , Jennifer C. Lai MD, MBA , Sharad I. Wadhwani MD, MPH\",\"doi\":\"10.1016/j.jpeds.2025.114717\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>To characterize how neighborhood socioeconomic deprivation affects tissue transglutaminase (tTG) IgA normalization, a marker of effective gluten elimination.</div></div><div><h3>Study design</h3><div>We conducted a single-center, retrospective cohort study of 207 children ≤18 years old with serology- or biopsy-based celiac disease diagnosed between 2013 and 2023. The primary exposure was the neighborhood deprivation index, a continuous measure (0-1) derived from the 2018 5-year American Community Survey. We categorized children from lowest to highest deprivation by quartiles (Q): Q1 (<0.15), Q2 (0.15-0.21), Q3 (0.21-0.29), or Q4 (>0.29). The primary outcome was tTG IgA normalization over the 60 months after seropositivity. We used Cox regression models to estimate hazard ratios (HRs) for tTG IgA normalization, adjusting for race, ethnicity, primary-spoken language, and insurance type in multivariable analyses.</div></div><div><h3>Results</h3><div>Of 207 children, the median deprivation index was 0.22 (IQR: 0.14, 0.29). Higher deprivation was associated with participants identifying as Black or Other race, Hispanic, non-English primary-speaking, and having public insurance. In univariate analysis, children in the highest quartile of neighborhood deprivation had a 50% lower normalization rate compared with those in the lowest quartile (HR 0.50; 95% confidence interval 0.27, 0.92; <em>P</em> = .03). In multivariable analysis, children in the highest quartile of neighborhood deprivation sustained a 67% lower normalization rate after adjusting for race, ethnicity, primary-spoken language, and insurance type (HR0.33; 95% confidence interval 0.15, 0.75; <em>P</em> = .008).</div></div><div><h3>Conclusions</h3><div>Children living in socioeconomically deprived neighborhoods may have inadequate dietary adherence. Addressing the barriers to gluten elimination in deprived neighborhoods may improve outcomes.</div></div>\",\"PeriodicalId\":54774,\"journal\":{\"name\":\"Journal of Pediatrics\",\"volume\":\"286 \",\"pages\":\"Article 114717\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-07-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022347625002586\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022347625002586","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Neighborhood Socioeconomic Deprivation Associates with Decreased Serologic Normalization Rates in Pediatric Celiac Disease
Objective
To characterize how neighborhood socioeconomic deprivation affects tissue transglutaminase (tTG) IgA normalization, a marker of effective gluten elimination.
Study design
We conducted a single-center, retrospective cohort study of 207 children ≤18 years old with serology- or biopsy-based celiac disease diagnosed between 2013 and 2023. The primary exposure was the neighborhood deprivation index, a continuous measure (0-1) derived from the 2018 5-year American Community Survey. We categorized children from lowest to highest deprivation by quartiles (Q): Q1 (<0.15), Q2 (0.15-0.21), Q3 (0.21-0.29), or Q4 (>0.29). The primary outcome was tTG IgA normalization over the 60 months after seropositivity. We used Cox regression models to estimate hazard ratios (HRs) for tTG IgA normalization, adjusting for race, ethnicity, primary-spoken language, and insurance type in multivariable analyses.
Results
Of 207 children, the median deprivation index was 0.22 (IQR: 0.14, 0.29). Higher deprivation was associated with participants identifying as Black or Other race, Hispanic, non-English primary-speaking, and having public insurance. In univariate analysis, children in the highest quartile of neighborhood deprivation had a 50% lower normalization rate compared with those in the lowest quartile (HR 0.50; 95% confidence interval 0.27, 0.92; P = .03). In multivariable analysis, children in the highest quartile of neighborhood deprivation sustained a 67% lower normalization rate after adjusting for race, ethnicity, primary-spoken language, and insurance type (HR0.33; 95% confidence interval 0.15, 0.75; P = .008).
Conclusions
Children living in socioeconomically deprived neighborhoods may have inadequate dietary adherence. Addressing the barriers to gluten elimination in deprived neighborhoods may improve outcomes.
期刊介绍:
The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy.
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