Socioeconomic and racial disparities in Guillain-Barré syndrome.

Abstract

Objectives: Guillain-Barré syndrome (GBS) is a rapidly progressive neuromuscular disorder that often requires intensive care and immunomodulatory therapy. Despite standardized treatment approaches, access to care and outcomes may be influenced by social determinants of health. We evaluated associations between socioeconomic and racial factors and inpatient interventions and outcomes in GBS in the US.

Study design: Retrospective cohort study.

Methods: This retrospective cohort study used data from the National Inpatient Sample (2016-2021) to identify hospitalizations with a primary diagnosis of GBS ( International Statistical Classification of Diseases, Tenth Revision code G61.0). Multivariable logistic regression models assessed associations between demographic and socioeconomic variables and 5 prespecified outcomes: in-hospital mortality, nonroutine discharge, prolonged hospitalization, receipt of intravenous immunoglobulin (IVIG), and receipt of plasmapheresis.

Results: We analyzed 45,515 GBS-related hospitalizations (patients' mean age, 50.7 years; 46.0% female). After adjusting for covariates, higher zip code income was associated with reduced inpatient mortality (OR per quartile, 0.80; 95% CI, 0.66-0.98). Admission to private investor-owned hospitals was associated with lower IVIG or plasmapheresis use, an effect not seen when analyzing only privately insured patients. Black patients were less likely to receive plasmapheresis (OR, 0.75; 95% CI, 0.59-0.95). Black and Native American patients had higher odds of nonroutine discharge (Black: OR, 1.26; 95% CI, 1.06-1.51; Native American: OR, 2.16; 95% CI, 1.20-3.88). Medicare coverage was associated with higher odds of nonroutine discharge (OR, 1.90; 95% CI, 1.62-2.23), and Medicaid coverage was associated with prolonged hospitalization (OR, 1.73; 95% CI, 1.48-2.02). Self-pay was linked to reduced odds of nonroutine discharge but longer hospitalization (OR, 0.53; 95% CI, 0.43-0.66).

Conclusions: This study reveals socioeconomic, racial, and institutional disparities in GBS hospitalization outcomes despite standardized treatment guidelines. These findings highlight the need for equity-focused strategies to ensure timely and consistent care for patients with acute neurologic conditions.