Idiopathic Intracranial Hypertension in the United States: Demographic and Socioeconomic Disparities

Arash Ghaffari-Rafi; Rana Mehdizadeh; Andrew Wai Kei Ko; Shadeh Ghaffari-Rafi; Jose Leon-Rojas

doi:10.3389/fneur.2020.00869

Idiopathic Intracranial Hypertension in the United States: Demographic and Socioeconomic Disparities

Front Neurol. 2020 Sep 8:11:869. doi: 10.3389/fneur.2020.00869. eCollection 2020.

Authors

Arash Ghaffari-Rafi^{1

2}, Rana Mehdizadeh³, Andrew Wai Kei Ko¹, Shadeh Ghaffari-Rafi⁴, Jose Leon-Rojas^{2

5}

Affiliations

¹ John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, United States.
² Queen Square Institute of Neurology, University College London, London, United Kingdom.
³ Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
⁴ Carver College of Medicine, University of Iowa, Iowa City, IA, United States.
⁵ Universidad Internacional del Ecuador Escuela de Medicina, Quito, Ecuador.

Abstract

Background: Obesity's risk increases for low-income, female, young, and Black patients. By extrapolation, idiopathic intracranial hypertension (IIH)-a disease associated with body mass index-would potentially display socioeconomic and demographic disparities. Methods: IIH incidence (per 100,000) was investigated with respect to sex, age, income, residence, and race/ethnicity, by querying the largest United States (US) healthcare administrative dataset (1997-2016), the National (Nationwide) Inpatient Sample. Results: Annual national incidence (with 25th and 75th quartiles) for IIH was 1.15 (0.91, 1.44). Females had an incidence of 1.97 (1.48, 2.48), larger (p = 0.0000038) than males at 0.36 (0.26, 0.38). Regarding age, largest incidence was among those 18-44 years old at 2.47 (1.84, 2.73). Low-income patients had an incidence of 1.56 (1.47, 1.82), larger (p = 0.00024) than the 1.21 (1.01, 1.36) of the middle/high. No differences (χ² = 4.67, p = 0.097) were appreciated between urban (1.44; 1.40, 1.61), suburban (1.30; 1.09, 1.40), or rural (1.46; 1.40, 1.48) communities. For race/ethnicity (χ² = 57, p = 2.57 × 10^-12), incidence was largest for Blacks (2.05; 1.76, 2.74), followed by Whites (1.04; 0.79, 1.41), Hispanics (0.67; 0.57, 0.94), and Asian/Pacific Islanders (0.16; 0.11, 0.19). Year-to-year, incidence rose for all strata subsets except Asian/Pacific Islanders (τ = -0.84, p = 0.00000068). Conclusion: IIH demonstrates several sociodemographic disparities. Specifically, incidences are larger for those low-income, Black, 18-44 years old, or female, while annually increasing for all subsets, except Asian/Pacific Islanders. Hence, IIH differentially afflicts the US population, yielding in healthcare inequalities.

Keywords: United States; demographics; disparities; idiopathic intracranial hypertension; incidence; income; socioeconomic.