To characterize the social determinants of health (SDOH) impacting anti-NMDAR encephalitis patients.

Anti-NMDAR encephalitis is a rare autoimmune neurologic condition characterized by complex neuropsychiatric symptoms including psychosis, behavioral changes, memory deficits, seizures, abnormal movements, and autonomic dysregulation. Preliminary analysis of population databases by our group showed that many of our patients encountered multiple SDOH inequities, having lived in disadvantaged areas compared to both the state and national average. 

This is a patient-reported outcome study of 24 anti-NMDAR encephalitis patients from the University of Utah Health seen between January 2012 - August 2022. We captured SDOH related to economic stability, educational access, healthcare access, neighborhood environment, and community support via telephone interview, while correlating this with retrospectively collected clinical outcomes. 

58.3% (n=14) were male and 50% (n=12) were white/non-Hispanic. Average age of diagnosis was 24.8 [5-82]. The median time from symptom onset to confirmatory NMDAR IgG Antibody Assay was 25.5 days. Distribution of insurance revealed 37.5% (n=9) had private insurance, 45.8% (n=11) had government insurance, 4.2% (n=1) had a combination of private and government insurance, and 12.5% (n=3) of patients were uninsured. Further sensitivity analysis will be conducted to understand the correlation between individual SDOH and clinical outcomes.

We have previously determined that patients with anti-NMDAR encephalitis in this cohort represent the moderately to moderate-to-most disadvantaged populations within a large catchment area. This study will further categorize specific SDOH related to economic stability, educational access, healthcare access, neighborhood environment, and community support in this patient population through one-on-one phone interviews. Identification of the SDOH obstacles encountered by this population will enable us to identify modifiable factors which can promote timely diagnosis and to direct interventions informed by patient reported SDOH.