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Abstract Details

Inpatient and Emergency Department Epidemiology and Differences Across Health Disparity Populations in People with Functional Neurological Disorders
Health Care Disparities
P3 - Poster Session 3 (5:30 PM-6:30 PM)
4-014

To assess inpatient and emergency department (ED) epidemiology and healthcare disparities in functional neurological disorder (FND) in adults and children.

FND have high costs and healthcare utilization, comparable with investigation/pharmacologically-intensive neurological disorders. There are scant reports on the epidemiology of FND and related disparities.

We used 2019 data from large federal healthcare databases to assess adult (age >18) and pediatric (5-17 years) inpatient hospitalizations and adult/pediatric ED visits. ICD-10-CM codes for functional neurological symptom disorder (F.44.4-F44.7) defined FND and its subgroups. We assessed differences in discharge disposition by age, sex, race/ethnicity, ZIP code income quartile, urban/rural residence, and insurance type, and differences in healthcare utilization, patient charges, and inpatient length of stay within FND/subgroups.

In adult FND hospitalizations, females vs. males (65.95% vs. 56.98%) and Native American (73.77%) and Hispanic (65.78%) vs. White (63.69%) FND patients were more commonly discharged home; patients in the highest (57.87%) ZIP code income quartile were less likely discharged home vs. the lowest quartile (64.52%), all p<0.01. In pediatric FND hospitalizations, White patients were more commonly discharged home (p=0.0004), while discharge disposition was otherwise similar between groups.

In adult ED presentations, FND patients >65 years (16.49%) were less likely discharged home vs. 18-40 years (61.67%), p<0.0001. In pediatric ED presentations, FND in the lowest ZIP code income quartile were most commonly discharged home (72.12%) vs. the highest (63.45%), p<0.0001.

Functional attacks/seizures were the most common FND subtype, followed by motor FND (movement/weakness). In adults, race was similar across subtypes but in children, motor FND was more racially diverse. Length of stay and per patient charges in adult/pediatric FND admissions were higher in older age, males, highest zip code income quartile, urban settings, and differed by race (highest in Asians) and FND subtype.

We found age, sex, race and income differences in FND and its subtypes.
Authors/Disclosures
Christopher D. Stephen, MB ChB, FRCP, MSc, SM
PRESENTER 		The institution of Dr. Stephen has received research support from Sanofi. Dr. Stephen has received research support from National Institutes of Health.
Vicki Fung An immediate family member of Vicki Fung has received personal compensation for serving as an employee of Vertex Pharmaceuticals. An immediate family member of Vicki Fung has stock in Vertex Pharmaceuticals. The institution of Vicki Fung has received research support from NIH. The institution of Vicki Fung has received research support from AHRQ. The institution of Vicki Fung has received research support from Google LLC.
Codrin I. Lungu, MD, FAAN Dr. Lungu has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier, inc..
David L. Perez, MD, FAAN (Massachusetts General Hospital) Dr. Perez has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley: Brain and Behavior. Dr. Perez has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Psychiatric Association Publishing. The institution of Dr. Perez has received research support from NIH. The institution of Dr. Perez has received research support from Sidney R. Baer Jr. Foundation. The institution of Dr. Perez has received research support from Warren Alpert Foundation. Dr. Perez has received publishing royalties from a publication relating to health care. Dr. Perez has received publishing royalties from a publication relating to health care.
Alberto J. Espay, MD, FAAN (University of Cincinnati) Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Tanabe Pharma America (formerly, Neuroderm). Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avion. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acadia. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acorda. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyowa Kirin. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sunovion. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Herantis Pharma. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Supernus (formerly USWorldMeds). Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acadia. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Synaps Dx. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bial. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for NeuroDiagnostics, Inc (SYNAPS Dx). Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Intrance Medical Systems, Inc.. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Praxis Precision Medicines. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Citrus Health. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AskBio. The institution of Dr. Espay has received research support from NIH. The institution of Dr. Espay has received research support from Michael J Fox Foundation for Parkinson's Research. Dr. Espay has received intellectual property interests from a discovery or technology relating to health care. Dr. Espay has received publishing royalties from a publication relating to health care. Dr. Espay has received publishing royalties from a publication relating to health care. Dr. Espay has received publishing royalties from a publication relating to health care.