Center for Multicultural Mental Health Research, Cambridge Health Alliance, Cambridge, MA, USA.
Headache. 2015 Feb;55(2):214-28. doi: 10.1111/head.12506. Epub 2015 Feb 3.
The prevalence and burden of migraine and other severe headaches in the US population as a whole is well documented. Prevalence and treatment patterns in US racial and ethnic minorities, however, have received less attention. We sought to assemble and compare this information as identified in large, nationally representative studies.
We searched for summary statistics from studies performed in the United States between 1989 and 2014. Included studies had to provide population-based, nationally or broadly representative information on the prevalence, burden, or treatment of severe or frequent headache or migraine in adult US Blacks, Hispanics, Native Americans, or Asians.
Nine studies were included in the review. Prevalence data from the National Health Interview Survey (NHIS) provide the most comprehensive information for major racial and ethnic groups. The average prevalence of severe headache or migraine from 2005 to 2012 NHIS was 17.7% for Native Americans, 15.5% for Whites, 14.5% for Hispanics, 14.45% for Blacks, and 9.2% for Asians. Severe headache or migraine prevalence was higher in females of all races and ethnic groups compared with males and across all included studies. Female to male prevalence ratios from the 2005-2012 NHIS were 2.1 for Whites, 2.5 for Hispanics, 2.1 for Blacks, and 2.0 for Asians. Among those with chronic migraine (≥15 days of headache per month), prevalence data from the American Migraine Prevalence and Prevention study showed that the prevalence of chronic migraine was highest in Hispanic women (2.26% compared with 1.2% for White females), whereas White males had the lowest prevalence at 0.46%. Data from the National Hospital Ambulatory Care Survey and National Ambulatory Care Survey show that Hispanics make only 89.5 annual ambulatory care visits per 10,000 population at which they receive a diagnosis of migraine, compared with 176.3 for Whites and 133.2 for Blacks. In contrast, visit rates resulting in a diagnosis of nonspecific headache were more comparable across all groups. Only one study obtained information on selected subgroups within Hispanic and Asian populations. This showed that differences among these subgroups, which suggest composite prevalence estimates for broadly defined racial and ethnic groups such as Asians, may conceal meaningful differences in subgroups, such as Vietnamese or Filipinos.
In the United States, migraine prevalence is highest among Native Americans, then Whites, followed closely by Hispanics and Blacks. Asians have the lowest prevalence of severe, frequent headache or migraine of the major racial or ethnic groups. Differences in diagnosis and treatment of headache and migraine may indicate racial and ethnic disparities in access and quality of care for minority patients.
偏头痛和其他严重头痛在美国人群中的流行程度和负担已有充分记录。然而，美国种族和族裔少数群体的流行程度和治疗模式受到的关注较少。我们试图在大型全国代表性研究中收集和比较这些信息。
我们搜索了 1989 年至 2014 年在美国进行的研究的汇总统计数据。纳入的研究必须提供基于人群的、全国性或广泛代表性的关于美国黑种人、西班牙裔、美洲原住民或亚洲成年人严重或频繁头痛或偏头痛的流行程度、负担或治疗的信息。
综述纳入了 9 项研究。国家健康访谈调查 (NHIS) 的患病率数据为主要种族和族裔群体提供了最全面的信息。2005 年至 2012 年 NHIS 的严重头痛或偏头痛平均患病率为：美洲原住民 17.7%、白人 15.5%、西班牙裔 14.5%、黑种人 14.45%、亚洲人 9.2%。在所有种族和族裔群体中，女性的严重头痛或偏头痛患病率均高于男性，且在所有纳入的研究中均如此。2005 年至 2012 年 NHIS 的女性与男性患病率比为：白人 2.1、西班牙裔 2.5、黑种人 2.1、亚洲人 2.0。在慢性偏头痛（每月头痛≥15 天）患者中，美国偏头痛患病率和预防研究的数据显示，西班牙裔女性的慢性偏头痛患病率最高（2.26%，而白人女性为 1.2%），而白人男性的患病率最低，为 0.46%。国家医院门诊医疗调查和国家门诊医疗调查的数据显示，西班牙裔每 10000 人每年接受偏头痛诊断的门诊就诊次数仅为 89.5 次，而白人为 176.3 次，黑人为 133.2 次。相比之下，导致非特异性头痛诊断的就诊次数在所有群体中更为可比。只有一项研究获得了西班牙裔和亚洲人群中某些亚组的信息。结果表明，这些亚组之间的差异表明，广泛定义的种族和族裔群体（如亚洲人）的复合患病率估计可能掩盖了这些亚组之间的有意义差异，例如越南裔或菲律宾裔。
在美国，偏头痛的患病率在美洲原住民中最高，其次是白人，然后是西班牙裔和黑人。亚洲人严重、频繁头痛或偏头痛的患病率在主要种族或族裔群体中最低。头痛和偏头痛的诊断和治疗差异可能表明少数族裔患者在获得和护理质量方面存在种族和民族差异。
