Disparities in Access to Specialized Care for Spontaneous Intracranial Hypotension.

Background and purpose: Patients with spontaneous intracranial hypotension (SIH) often face substantial delays in diagnosis and treatment. Barriers to accessing specialized care for SIH remain poorly understood, particularly with regard to potential demographic and/or socioeconomic disparities. The purpose of this study is to evaluate whether patients seen in a specialized CSF leak clinic differ demographically or socioeconomically from those presenting to the emergency department (ED) with headache who receive neuroimaging.

Materials and methods: We retrospectively compared all patients evaluated in the University of Colorado CSF Leak Program in March 2025 to patients presenting to the ED at our institution during the same month with a primary complaint of headache who underwent neuroimaging. Demographic and socioeconomic variables were extracted from the electronic medical record and compared between groups using the chi-square test, t-tests, or the Mann-Whitney U test, as appropriate.

Results: A total of 95 patients from the CSF leak clinic and 130 patients from the ED headache clinic were included in this study. Patients seen in the CSF leak clinic were significantly more likely to be female (76.8% vs. 57.7%, χ2=8.9, p=0.003), white (89.5% vs. 47.7%, χ2=45.5, p <0.001), have private insurance (72.6% vs. 41.5%, χ2=27.91, p <0.001), and report English as their primary language (96.8% vs. 75.4%, χ2=21.3, p <0.001). The median driving distance to the hospital was substantially longer in the CSF clinic cohort (23 miles, IQR 12-70 vs. 7 miles, IQR 6-12; Mann-Whitney U = 9562, p <0.001). ZIP code-based household income did not differ significantly between groups ($98,000 vs. $91,000; t = 1.20, p = 0.11).

Conclusions: Patients accessing specialized care for SIH at a tertiary referral center are more likely to be white, English-speaking, and privately insured compared to patients presenting to the ED with headache, despite coming from farther geographic distances. These findings suggest significant disparities in access to specialty care for SIH, highlighting the need for targeted outreach, streamlined referral pathways, and broader diagnostic awareness in general practice and emergency settings.

Abbreviations: SIH＝ Spontaneous intracranial hypotension.