Abstract Details

Title Nationwide Incidence and Associated Morbidity of Idiopathic Normal Pressure Hydrocephalus in Medicare Beneficiaries

Topic General Neurology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 11-008

Objective Assess the risk factors and geographic distribution of idiopathic normal pressure hydrocephalus (NPH) in the United States (U.S.).

Background The etiology and healthcare burden of NPH in the U.S. is unknown. Population-based studies, such as those using Medicare data, have the potential to address that knowledge gap.

Design/Methods Using Medicare beneficiaries from 2017-2018, we conducted a case-control study of incident NPH cases (n=5,573) and matched controls (n=34,467), excluding cases with shunts or diagnoses indicative of secondary hydrocephalus. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for all ICD-10 diagnosis codes in the year prior to NPH diagnosis or control reference date, adjusted for demographics (sex, age, race, healthcare utilization, and smoking), and applied Bonferroni correction. Diagnoses for significant ICD-10 codes were grouped based on clinical similarity and odds ratios for groups were recalculated. County-level standardized incidence ratios (SIRs) were calculated adjusting for sex, age, and race, and then mapped with spatial smoothing. Bivariate local indicators of spatial association (BiLISA) analysis was used to evaluate the relationship between SIRs and the density of neurosurgeons.

Results NPH cases were more likely to be older (p<0.01), male (p<0.01), and smokers (p<0.01). Diagnosis codes for cognitive impairment (OR=5.66, 95% CI:5.31-6.05), movement disorders (OR=5.13, 95% CI:4.81-5.47), urinary incontinence (OR=2.00, 95% CI:1.88-2.14), insomnia (OR=1.51, 95% CI:1.33-1.71), mental health disorders (OR=2.14, 95% CI:1.99-2.29), and cardiovascular disease (OR=1.30, 95% CI:1.22-1.39) were positively associated with NPH. Higher SIRs were observed in Southern California, Florida, and Texas. BiLISA results showed SIRs in these regions were positively correlated with the density of neurosurgeons.

Conclusions Prodromal NPH symptoms and cardiovascular disease are strongly associated with incident NPH diagnosis. NPH incidence varies regionally, but many high incidence regions are correlated with local neurosurgical expertise.

Authors/Disclosures
Srishti Rajeev PRESENTER	Ms. Rajeev has nothing to disclose.
Jordan A. Killion, PhD (Barrow Neurological Institute)	Dr. Killion has received personal compensation for serving as an employee of CommonSpirit Health. The institution of Dr. Killion has received research support from The Michael J. Fox Foundation for Parkinson's Research (MJFF-000939). The institution of Dr. Killion has received research support from Department of Defense Grant (PD190057). The institution of Dr. Killion has received research support from Barrow Neurological Foundation. The institution of Dr. Killion has received research support from Kemper and Ethel Marley Foundation. The institution of Dr. Killion has received research support from Moreno Family.
Irene Faust, MPH (Barrow Neurological Institute)	Ms. Faust has nothing to disclose.
Sai Anmisha Doddamreddy, MS	Miss Doddamreddy has nothing to disclose.
Brittany Krzyzanowski, PhD	Dr. Krzyzanowski has nothing to disclose.
Justin Hoskin, MD (Barrow Neurological Institute)	Dr. Hoskin has nothing to disclose.
Brad A. Racette, MD, FAAN (Barrow Neurological Institute)	Dr. Racette has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for American Regent. Dr. Racette has received personal compensation in the range of $500-$4,999 for serving as a advisory council with NIEHS.

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