Department of Psychiatry, Trinity Centre for Health Sciences, School of Medicine Trinity College Dublin, the University of Dublin, Dublin, Ireland.
BIDMC Comprehensive Headache Center, Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
J Natl Med Assoc. 2022 Jan;113(6):671-679. doi: 10.1016/j.jnma.2021.07.004. Epub 2021 Aug 9.
Despite the growing awareness across the general population, migraine is often underdiagnosed and undertreated in socially and economically marginalized groups. The present study aimed to investigate the differential effects of race and income on other sociodemographic data and hospital length of stay in patients admitted to hospital with a primary diagnosis of migraine headache.
We utilized the Nationwide Inpatient Sample (NIS) database to identify patients admitted from 2004 to 2017 with a primary diagnosis of migraine. Information on demographic and length of stay data was obtained. Only patients older than 18 years were selected and age outliers were excluded. Race groups were identified as "Caucasian", "African American", "Hispanic", "Asian or Pacific Islander", "Native American", or "Others". Income was identified as the estimated median household income of residents in the patient's ZIP Code.
A total of 106,761,737 valid cases were identified. After applying our case inclusion criteria, only 61453 (median age = 42 years, range = 18-78 years) were included. Patients identified as "African American", "Hispanic" or "Native American" were more likely to have lower household income (p< 0.001), whereas higher income was found for the patients identified as "Caucasian", even when men and women were considered separately (p< 0.001). No effects of race and/or household income was found on the length of stay in hospital.
The occurrence of migraine diagnosis on hospital admission in the USA can be impacted by culturally driven patient-clinician communication differences between ethnic groups.
摘要
尽管普通人群对偏头痛的认识不断提高，但在社会和经济边缘化群体中，偏头痛常常被漏诊和治疗不足。本研究旨在调查种族和收入对其他社会人口统计学数据和偏头痛患者住院时间的差异影响。
我们利用全国住院患者样本（NIS）数据库，确定了 2004 年至 2017 年间因偏头痛初诊住院的患者。获取了人口统计学和住院时间数据的信息。仅选择年龄大于 18 岁的患者，并排除年龄异常值。种族群体被确定为“白种人”、“非裔美国人”、“西班牙裔”、“亚洲或太平洋岛民”、“美洲原住民”或“其他”。收入被确定为患者所在邮政编码居民的估计中位数家庭收入。
共确定了 106761737 个有效病例。在应用我们的病例纳入标准后，仅纳入了 61453 例（中位数年龄为 42 岁，范围为 18-78 岁）。被确定为“非裔美国人”、“西班牙裔”或“美洲原住民”的患者更有可能家庭收入较低（p<0.001），而被确定为“白种人”的患者收入较高，即使分别考虑男性和女性也是如此（p<0.001）。种族和/或家庭收入对住院时间没有影响。
在美国，偏头痛的入院诊断可能受到不同族裔群体之间文化驱动的医患沟通差异的影响。
