Evaluation of Racial, Ethnic, and Socioeconomic Disparities in Idiopathic Intracranial Hypertension

Abstract

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.