Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2021; 27(12): 1213-1225
Published online Mar 28, 2021. doi: 10.3748/wjg.v27.i12.1213
Risk perception and knowledge of COVID-19 in patients with celiac disease
Jamie Zhen, Juan Pablo Stefanolo, María de la Paz Temprano, Caroline L Seiler, Alberto Caminero, Enrique de-Madaria, Miguel Montoro Huguet, Vivas Santiago, Sonia Isabel Niveloni, Edgardo Gustavo Smecuol, Luis Uzcanga Dominguez, Elena Trucco, Virginia Lopez, Carolina Olano, Pasquale Mansueto, Antonio Carroccio, Peter H Green, Donald Duerksen, Andrew S Day, Jason A Tye-Din, Julio César Bai, Carolina Ciacci, Elena F Verdú, Benjamin Lebwohl, M Ines Pinto-Sanchez
Jamie Zhen, Caroline L Seiler, Alberto Caminero, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University Medical Center, Hamilton Health Sciences, Hamilton L8S4K1, ON, Canada
Juan Pablo Stefanolo, María de la Paz Temprano, Sonia Isabel Niveloni, Edgardo Gustavo Smecuol, Julio César Bai, Department of Medicine, Dr. C. Bonorino Udaondo Gastroenterology Hospital, Buenos Aires 1264, Argentina
Enrique de-Madaria, Department of Pancreatic Unit, Hospital General Universitario de Alicante, Alicante 03010, Spain
Miguel Montoro Huguet, Department of Medicine, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza 50009, Spain
Miguel Montoro Huguet, Department of Medicine, Hospital Universitario San Jorge. Huesca, Zaragoza 50004, Spain
Vivas Santiago, Department of Gastroenterology, Univ Hosp Leon, Gastroenterol Unit, Altos de Nava S-N, Leon 24071, Spain
Luis Uzcanga Dominguez, Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico DF 14080, Mexico
Elena Trucco, Virginia Lopez, Carolina Olano, Department of Medicine, Universidad de la Republic, Montevideo 11800, Uruguay
Pasquale Mansueto, Department of Internal Medicine, PROMISE Department, University of Palermo, Palermo 90127, Italy
Antonio Carroccio, Department of Internal Medicine, V. Cervello Hospital, PROMISE Department, University of Palermo, Palermo 90127, Italy
Peter H Green, Celiac Disease Center, Columbia University Medical Center, Columbia Univ, Celiac Dis Ctr, Div Digest and Liver Dis, New York, NY 10032, United States
Donald Duerksen, Department of Medicine, St Boniface Gen Hosp, University of Manitoba, Winnipeg R2H 2A6, Canada
Andrew S Day, Department of Paediatrics, University of Otago Christchurch, Christchurch 8041, New Zealand
Jason A Tye-Din, Department of Gastroenterology, Royal Melbourne Hospital, Immunology Division, Walter and Eliza Hall Institute, Melbourne 3052, Australia
Carolina Ciacci, Department of Medicine, Surgery and Dentry, Scuola Medica Salernitana, University of Salerno, Celiac Center at the University Hospital San Giovanni di Dio e Ruggi di Aragona, Salerno 84131, Italy
Elena F Verdú, M Ines Pinto-Sanchez, Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton L8S4K1, ON, Canada
Benjamin Lebwohl, The Celiac Disease Center, Columbia University, New York, NY 10032, United States
Author contributions: Zhen J, Stefanolo JP and Pinto-Sanchez MI collected, analyzed, interpreted the data, and drafted the manuscript; Zhen J, Stefanolo JP, Temprano MDLP, Seiler CL, Caminero A, de-Madaria E, Huguet MM, Santiago V, Niveloni SI, Smecuol EG, Dominguez LU, Trucco E, Lopez V, Olano C, Mansueto P, Carroccio A, Green PH, Duerksen D, Day AS, Tye-Din JA, Bai JC, Ciacci C, Verdú EF, Lebwohl B, and Pinto-Sanchez MI collected data, and critically revised the manuscript for intellectual content; Pinto-Sanchez MI conceived, designed, and supervised the study; all authors approved of the final manuscript.
Institutional review board statement: The study was approved by the Hamilton Integrated Research Ethics Board (Hamilton, Ontario), No. HIREB# 5414.
Informed consent statement: All participants volunteered to participate in the study.
Conflict-of-interest statement: MIPS received in kind support for the Modulen formula from Nestle Canada, consultant honoraria from Takeda, Baxter and Frezenius Kabi unrelated to this manuscript. ASD has received honoraria from Janseen, Abbvie, Nestle and Sanofi unrelated to this manuscript. All other authors have no financial disclosures or relevant conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: M Ines Pinto-Sanchez, MD, MSc, Academic Research, Assistant Professor, Consultant Physician-Scientist, Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, 1280 Main Street West, Hamilton L8S4K1, ON, Canada. pintosm@mcmaster.ca
Received: November 28, 2020
Peer-review started: November 28, 2020
First decision: December 24, 2020
Revised: January 7, 2021
Accepted: March 12, 2021
Article in press: March 12, 2021
Published online: March 28, 2021
Processing time: 113 Days and 12.5 Hours
Abstract
BACKGROUND

We recently demonstrated that the odds of contracting coronavirus disease 2019 (COVID-19) in patients with celiac disease (CeD) is similar to that of the general population. However, how patients with CeD perceive their COVID-19 risk may differ from their actual risk.

AIM

To investigate risk perceptions of contracting COVID-19 in patients with CeD and determine the factors that may influence their perception.

METHODS

We distributed a survey throughout 10 countries between March and June 2020 and collected data on demographics, diet, COVID-19 testing, and risk perceptions of COVID-19 in patients with CeD. Participants were recruited through various celiac associations, clinic visits, and social media. Risk perception was assessed by asking individuals whether they believe patients with CeD are at an increased risk of contracting COVID-19 when compared to the general population. Logistic regression was used to determine the influencing factors associated with COVID-19 risk perception, such as age, sex, adherence to a gluten-free diet (GFD), and comorbidities such as cardiac conditions, respiratory conditions, and diabetes. Data was presented as adjusted odds ratios (aORs)

RESULTS

A total of 10737 participants with CeD completed the survey. From them, 6019 (56.1%) patients with CeD perceived they were at a higher risk or were unsure if they were at a higher risk of contracting COVID-19 compared to the non-CeD population. A greater proportion of patients with CeD perceived an increased risk of contracting COVID-19 when compared to infections in general due to their CeD (56.1% vs 26.7%, P < 0.0001). Consequently, 34.8% reported taking extra COVID-19 precautions as a result of their CeD. Members of celiac associations were less likely to perceive an increased risk of COVID-19 when compared to non-members (49.5% vs 57.4%, P < 0.0001). Older age (aOR: 0.99; 95%CI: 0.99 to 0.99, P < 0.001), male sex (aOR: 0.84; 95%CI: 0.76 to 0.93, P = 0.001), and strict adherence to a GFD (aOR: 0.89; 95%CI: 0.82 to 0.96, P = 0.007) were associated with a lower perception of COVID-19 risk and the presence of comorbidities was associated with a higher perception of COVID-19 risk (aOR: 1.38; 95%CI: 1.22 to 1.54, P < 0.001).

CONCLUSION

Overall, high levels of risk perceptions, such as those found in patients with CeD, may increase an individual’s pandemic-related stress and contribute to negative mental health consequences. Therefore, it is encouraged that public health officials maintain consistent communication with the public and healthcare providers with the celiac community. Future studies specifically evaluating mental health in CeD could help determine the consequences of increased risk perceptions in this population.

Keywords: Celiac disease; Gluten; Risk; Infection; Knowledge; Perception; Coronavirus; COVID-19

Core Tip: Risk perceptions describe an individual’s perceived susceptibility to a threat and directly influence their behavior. We conducted an international cross-sectional study to evaluate risk of contracting contracting coronavirus disease 2019 (COVID-19) in celiac disease and evaluated risk perception. Patients with celiac disease perceive they are at an increased risk of contracting COVID-19 due to their condition, which is opposite to current scientific evidence. A higher risk perception may have a negative impact in mental health, and therefore, we encourage healthcare providers, patient care groups, and public health officials to discuss the implications that COVID-19 may have on patients in relation to their specific conditions.