Idiopathic Intracranial Hypertension in the United States: Demographic and Socioeconomic Disparities

Abstract

Background: Obesity's risk increases for low-income, female, young, and Black patients. By extrapolation, idiopathic intracranial hypertension (IIH)-a disease associated with body mass index-would potentially display socioeconomic and demographic disparities. Methods: IIH incidence (per 100,000) was investigated with respect to sex, age, income, residence, and race/ethnicity, by querying the largest United States (US) healthcare administrative dataset (1997-2016), the National (Nationwide) Inpatient Sample. Results: Annual national incidence (with 25th and 75th quartiles) for IIH was 1.15 (0.91, 1.44). Females had an incidence of 1.97 (1.48, 2.48), larger (p = 0.0000038) than males at 0.36 (0.26, 0.38). Regarding age, largest incidence was among those 18-44 years old at 2.47 (1.84, 2.73). Low-income patients had an incidence of 1.56 (1.47, 1.82), larger (p = 0.00024) than the 1.21 (1.01, 1.36) of the middle/high. No differences (χ 2 = 4.67, p = 0.097) were appreciated between urban (1.44; 1.40, 1.61), suburban (1.30; 1.09, 1.40), or rural (1.46; 1.40, 1.48) communities. For race/ethnicity (χ 2 = 57, p = 2.57 × 10 −12), incidence was largest for Blacks (2.05; 1.76, 2.74), followed by Whites (1.04; 0.79, 1.41), Hispanics (0.67; 0.57, 0.94), and Asian/Pacific Islanders (0.16; 0.11, 0.19). Year-to-year, incidence rose for all strata subsets except Asian/Pacific Islanders (τ = −0.84, p = 0.00000068). Conclusion: IIH demonstrates several sociodemographic disparities. Specifically, incidences are larger for those low-income, Black, 18-44 years old, or female, while annually increasing for all subsets, except Asian/Pacific Islanders. Hence, IIH differentially afflicts the US population, yielding in healthcare inequalities.

Association of Amount of Weight Lost After Bariatric Surgery With Intracranial Pressure in Women With Idiopathic Intracranial Hypertension

“…Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure (ICP) that causes chronic headaches and papilledema with the risk of permanent visual loss. [1][2][3] Both the incidence and prevalence of IIH in preceding decades has increased, [4][5][6] linked with the worldwide obesity epidemic. 7 Modest weight gain (approximately 5% were people with obesity) is associated with an increased risk of developing IIH, and in those people who do not have obesity, recent weight gain is a risk.…”

“…Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure (ICP) that causes chronic headaches and papilledema with the risk of permanent visual loss. 1 - 3 Both the incidence and prevalence of IIH in preceding decades has increased, 4 - 6 linked with the worldwide obesity epidemic. 7 …”

A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension

“…We also found that highest educational level was much lower in IIH patients compared to GP controls. It has been reported that IIH seems to affect socioeconomic groups differently with higher risk of IIH in socially deprived groups (2,18,23), possibly due to inequalities in healthcare that should be highlighted.…”

Outcomes measures in idiopathic intracranial hypertension

“…[1] [6] The disease is more common in those who are socially disadvantaged. [6] [9] Important principles for the management of IIH have been agreed [1] where modifying the underlying pathophysiology, with weight management is key for all patients with typical disease and a raised body mass index. [4] In those with rapidly declining visual function, now between 7-9% of those with IIH [6], an emergency intervention is warranted to save sight.…”