Factors Associated with Delayed Diagnosis of Celiac Disease Among Adults: A Cross-Sectional Analysis

Abstract

Background: Celiac disease (CD) is a chronic autoimmune disorder precipitated by gluten ingestion in genetically predisposed individuals. Despite advancements in diagnostic methods, many adults experience significant delays in diagnosis, leading to increased morbidity and reduced quality of life.
Objectives: This study aimed to identify factors associated with delayed diagnosis of CD among adults in Al-Ahsa city, Saudi Arabia.
Methods: A cross-sectional study was conducted involving 432 adult patients diagnosed with CD between January 2023 and December 2023. Data were collected through medical record reviews and structured patient interviews. Delayed diagnosis was defined as a duration of more than two years from symptom onset to official diagnosis. Multivariate logistic regression analysis was performed to identify independent predictors of delayed diagnosis.
Results: Of the 432 patients, 63.9% experienced a diagnostic delay exceeding two years. Independent predictors of delayed diagnosis included non-classical symptom presentation (adjusted odds ratio [OR] = 2.28; 95% confidence interval [CI]: 1.49–3.50; p < 0.001), rural residence (OR = 1.62; 95% CI: 1.08–2.44; p = 0.020), lower educational level (primary education vs. tertiary education, OR = 2.14; 95% CI: 1.11–4.12; p = 0.023), and older age at diagnosis (per year increase, OR = 1.03; 95% CI: 1.01–1.05; p = 0.002). Patients with non-classical symptoms were more likely to receive initial misdiagnoses such as irritable bowel syndrome or iron-deficiency anemia, contributing to prolonged delays.
Conclusions: Delayed diagnosis of CD among adults is significantly influenced by non-classical symptom presentation, rural residence, lower educational levels, and older age. Enhancing clinician awareness of diverse CD manifestations, improving healthcare access in rural areas, and implementing educational interventions targeting both healthcare providers and patients may reduce diagnostic delays and improve outcomes.