Investigators Assess Racial, Sociodemographic Differences Associated With Migraine

The incidence of migraine diagnosis on hospital admission in the United States may be impacted by culturally driven patient-clinician communication differences between ethnic groups, according to new research published in the Journal of the National Medical Association.

Although migraine affects approximately 40 million individuals in the United States, it is often ignored and its impact on quality of life is misunderstood, particularly among minorities, authors explained.

“There’s still a constant need for updated data on the racial/ethnic and socioeconomic disparities in the general population across the national territory, in view of future attempts to improve health equity in the country,” they wrote.

To investigate the interplay between race/ethnicity, sex, and yearly income, and their differential effects on hospital primary admission diagnoses among migraineurs, researchers carried out a retrospective data analysis of inpatients diagnosed with migraine recorded in the Nationwide Inpatient Sample (NIS) database.

Approximately 8 million hospital admissions across 1000 US hospitals are included in the database, and researchers gleaned data recorded between 2004 and 2017. “Income was identified as estimated median household income of residents in the patient’s ZIP Code,” they noted, while “the variable is subdivided in 4 levels or income subgroups, identified by values of 1 to 4, indicating the poorest to wealthiest populations: (1) 0-25th percentile, (2) 26th to 50th percentile (3) 51st to 75th percentile, (4) 76th to 100th percentile.”

A total of 61,453 migraineurs were included in the final analyses with a median age of 42 (interquartile range [IQR] 18-78). The majority of patients (81.3%) were women.

Analyses revealed:

• Patients who identified as Black, Hispanic, or Native Americans were more likely to have lower household income (P < .001)
• There was higher income for the patients who identified as White, even when men and women were considered separately (P < .001)
• No effects of race and/or household income was found on the length of stay in hospital

There was an approximately 1:2 ratio between the percentages of White and Black patients in the lowest income subgroup, and this ratio was inverted when the highest income subgroup was considered

“While our results might add to previous findings indicating that low socioeconomic status directly affects access to migraine treatment in racial minorities, they should also be considered in a wider framework of even greater social disparities across the USA, which have been shown to significantly reduce access to health insurance hence making public hospitals the only affordable destination when seeking medical treatment,” researchers wrote.

Despite data indicating migraine affects 12% of the US population, the condition was the first diagnosis in only 0.06% of admitted patients in the current study, potentially indicating the majority of diagnoses are completed in private clinics only accessible by insurance holders. This finding suggests migraine among minorities may likely remain undiagnosed and untreated, authors purported.

Differences in how symptoms were reported or gathered throughout the country may have affected the overall number of cases reported, marking a limitation to the study. Information on race and sex was also missing in over 10% of cases and data on household income was missing in over 24% of cases.

“In the present retrospective study, we found that the incidence of migraine on hospital admission was differentially affected by race and income, both separately and combined,” researchers explained.

“While these 2 factors might have played a combined role in shaping migraine first diagnosis, frequency across the sociodemographic groups and culturally driven communication differences in symptom reporting should be considered,” they concluded.

Reference

Amico F, Ashina S, Parascandolo E, and Sharon R. Race, ethnicity, and other socioeconomic characteristics of patients with hospital admission for migraine in the United States. J Natl Med Assoc. Published online August 9, 2021. doi:10.1016/j.jnma.2021.07.004