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Abstract Details

Insurance-Based Differences in Time to Specialist Evaluation for Patients with Spontaneous Intracranial Hypotension (SIH)
Headache
P2 - Poster Session 2 (8:00 AM-9:00 AM)
12-004
To characterize the impact of health insurance type on time to evaluation by a spontaneous intracranial hypotension (SIH) specialist for patients with SIH.
SIH, or spinal cerebrospinal fluid leak, is a frequently underdiagnosed and misdiagnosed disorder characterized by orthostatic headache. The impact of insurance type on patient access to SIH specialists has not yet been investigated.
This is a sub-analysis of a retrospective, IRB-approved chart review (IRB #22D.519) that assessed migraine prevalence in SIH patients evaluated by an SIH specialist at a tertiary headache center. Electronic medical records of 41 patients, aged ≥18, from January 1, 2021 to September 1, 2023, were analyzed. Eligibility was determined by confirmed or probable SIH diagnosis based on Schievink 2011 criteria with at least one follow-up visit. Records were evaluated for patient demographics, employment status, insurance type, date of symptom onset, and date of presentation to SIH specialist.
Among the 30 patients who met inclusion criteria, the average age was 45.0±13.6 years, with a 1.3:1 female-to-male ratio. 93.3% were Caucasian, 3.3% were Asian-American/Pacific Islander, and 3.3% were non-Caucasian Hispanic/Latinx; 13.3% were on disability, 63.3% were working, and 13.3% were students. Publicly insured patients (23.3% of patients) had a longer average time to presentation to an SIH specialist compared to privately insured patients (76.7% of patients, 4.75±4.62 years vs. 1.53±2.05 years, p = 0.033). Patients had similar average follow-up encounters within an 18 month follow-up timeframe (3.14±1.07 for publicly insured vs 3.13±0.97 visits for privately insured, p = 0.977).
Public insurance is associated with a significantly longer time to evaluation by an SIH specialist compared to private insurance.  However, there is no significant difference in number of specialist follow-up visits based on insurance type. Further investigation into how socioeconomic barriers impact diagnosis and management in this rare condition is warranted.
Authors/Disclosures
Naomi Doshi
PRESENTER 		Ms. Doshi has nothing to disclose.
Divya Polu Ms. Polu has nothing to disclose.
Arashleen K. Pannu Ms. Pannu has nothing to disclose.
Adora Zhang Ms. Zhang has nothing to disclose.
Ahmed Taha Shahzad Mr. Shahzad has nothing to disclose.
Justin Nofar, MD Dr. Nofar has nothing to disclose.
Victor Wang, MD (Thomas Jefferson University Hospital) Dr. Wang has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Dr. Wang has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie.
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center) An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Cephalalgia. The institution of Dr. Yuan has received research support from NIH. The institution of Dr. Yuan has received research support from American Headache Society. The institution of Dr. Yuan has received research support from Pfizer. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Invited speaker with Chinese Stroke Association.
Simy K. Parikh, MD Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Parikh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Pain and Headache Reports. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Author with Medlink. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Faculty with Touch Independent Medical 好色先生 (touchIME) . Dr. Parikh has a non-compensated relationship as a Medical Advisory Board Member with Spinal CSF Leak Foundation that is relevant to AAN interests or activities.