特发性颅内高压的种族、民族和社会经济差异评估。

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY
Jane J Huang, Daniel Lovasz, Minchan Shi, Florian H Guillot, James B Davis, Amanda D Henderson
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引用次数: 0

摘要

背景:特发性颅内高压(IIH)不成比例地影响年轻,黑人,女性患者。然而,在不同种族和社会经济群体中描述IIH基线和结果特征的数据有限。本研究旨在比较来自不同种族、民族和参保人群的IIH的表现特征、初始MRI表现和视觉结果。方法:我们对2013年7月1日至2023年9月30日期间在一家学术四级护理中心就诊的IIH患者进行了回顾性图表回顾。收集的患者特征包括自我报告的种族和民族、保险状况、年龄和性别。临床特征包括腰椎穿刺(LP)开口压力;体重指数(BMI);视力(VA)、视野平均偏差、视网膜神经纤维层(RNFL)平均厚度;核磁共振的发现;出现症状(头痛、复视、短暂性视力障碍、搏动性耳鸣),接受治疗;以及遵守后续建议。如果患者在初次就诊前已经接受过IIH治疗,或者诊断数据不完整,则排除在外。使用线性、混合效应和逻辑回归模型来评估种族、民族和保险状况组之间的差异。差异有统计学意义,P < 0.05。结果:我们的研究纳入了241例患者。在最初评估时,按种族、民族和保险状况分层的两组在BMI、高颅内压症状、视觉功能或RNFL厚度方面没有统计学上的显著差异。黑人患者更有可能拥有医疗补助,而白人患者更有可能拥有私人保险(医疗补助:38%黑人vs 14%白人;私人:47%黑人vs 67%白人,P < 0.001)。黑人患者在最初的MRI检查中更有可能出现后球变平,医疗保险覆盖的患者的VA结果明显比医疗补助覆盖的患者差。在患者亚组的表现特征、临床结果或对随访建议的依从性方面没有其他统计学上的显著差异。结论:基于种族、民族或保险状况,IIH、BMI、LP开口压力或随访依从性的表现症状无统计学显著差异。医疗保险覆盖的患者的VA结果比医疗补助覆盖的患者更差。除此之外,各组的视觉结果相似。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of Racial, Ethnic, and Socioeconomic Disparities in Idiopathic Intracranial Hypertension.

Background: Idiopathic intracranial hypertension (IIH) disproportionately affects young, Black, female patients. However, there are limited data characterizing baseline and outcome features of IIH across racial and socioeconomic groups. This study aimed to compare presenting features, initial MRI findings, and visual outcomes of IIH from different racial, ethnic, and insured groups.

Methods: We conducted a retrospective chart review of patients with IIH seen at an academic quaternary care center between July 1, 2013, and September 30, 2023. Patient characteristics collected were self-reported race and ethnicity, insurance status, age, and sex. Clinical features included lumbar puncture (LP) opening pressure; body mass index (BMI); visual acuity (VA), visual field mean deviation, and average retinal nerve fiber layer (RNFL) thickness at presentation and follow up; MRI findings; presence of symptoms (headaches, diplopia, transient visual obscurations, pulsatile tinnitus), treatment(s); and adherence to follow-up recommendations. Patients were excluded if they were already treated for IIH before initial presentation or if diagnostic data were incomplete. Linear, mixed effect, and logistic regression models were used to evaluate differences between racial, ethnic, and insurance status groups. Statistical significance was set at P < 0.05.

Results: Our study included 241 patients. There were no statistically significant differences in BMI, presence of symptoms of high intracranial pressure, visual function, or RNFL thickness at initial evaluation between groups stratified by race, ethnicity, and insurance status. Black patients were more likely to have Medicaid coverage, whereas White patients were more likely to have private insurance (Medicaid: 38% Black vs 14% White; private: 47% Black vs 67% White, P < 0.001). Black patients were more likely to have posterior globe flattening on initial MRI, and patients with Medicare coverage had significantly worse VA outcomes than those with Medicaid coverage. There were no other statistically significant differences in presenting features, clinical outcomes, or adherence to follow-up recommendations across patient subgroups.

Conclusions: There were no statistically significant differences in presenting symptoms of IIH, BMI, LP opening pressure, or adherence to follow-up based on race, ethnicity, or insurance status. Patients with Medicare coverage had worse VA outcomes than those with Medicaid coverage. Otherwise, visual outcomes were similar across groups.

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来源期刊
Journal of Neuro-Ophthalmology
Journal of Neuro-Ophthalmology 医学-临床神经学
CiteScore
2.80
自引率
13.80%
发文量
593
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuro-Ophthalmology (JNO) is the official journal of the North American Neuro-Ophthalmology Society (NANOS). It is a quarterly, peer-reviewed journal that publishes original and commissioned articles related to neuro-ophthalmology.
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