Real-world barriers to health care utilization among people living with migraine: Insights from the All of Us Research Program.

Abstract

Objectives/background: This study was undertaken to compare health care utilization barriers between participants with medically diagnosed migraine and matched controls without diagnosed migraine. Migraine imposes a significant burden on individuals and on health care systems worldwide. The role of sociodemographic factors and comorbidities in shaping health care utilization for migraine remains insufficiently understood, necessitating further investigation.

Methods: The All of Us Research Program is a large-scale, prospective cohort study funded by the National Institutes of Health. It collects extensive demographic, lifestyle, and health information through self-reports and electronic health records. This analysis uses the Controlled Tier Dataset V7, covering participant data from May 2018 to May 2024. Participants with migraine were identified based on self-reported data from the survey and confirmation of a medical migraine diagnosis through electronic health records using Systematized Nomenclature of Medicine (SNOMED) codes. Additionally, migraine-free controls were propensity-matched to the migraine cases on age, sex, race, and income.

Results: We identified 8346 migraine cases and an equal number of controls. Each group had an average age of 53.3 years and was 87% female. Despite matching for demographic variables and income, people with migraine had significantly more financial, social, and access barriers than those without migraine. There were higher rates of financial difficulties (46.8% vs. 40.3%, p < 0.001) and more transportation issues (9.9% vs. 5.8%, p < 0.001). They also reported more frequent doctor visits within the past 6 months (93.6% vs. 88.9%, p < 0.001) and a greater number of total doctor visits annually compared to those free of diagnosed migraine (31.1% vs. 17.4%, p < 0.001).

Conclusion: This study highlights the significant financial, social, and access barriers faced by participants with migraine, alongside higher health care utilization, compared to those without diagnosed migraine despite matching for demographic variables and income. These findings underscore the substantial burden of migraine and emphasize the urgent need for targeted interventions to enhance health care accessibility and reduce the burden on affected individuals. These data do not capture the burden of undiagnosed migraine due to the method of case ascertainment.