Azzam Ahmed Y, Nassar Mahmoud, Morsy Mahmoud M, Mohamed Adham A, Wu Jin, Essibayi Muhammed Amir, Altschul David J
Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA.
Director of Clinical Research and Clinical Artificial Intelligence, American Society for Inclusion, Diversity, and Health Equity (ASIDE), Delaware, USA.
ASIDE Intern Med. 2025 Jan;1(1):31-39. doi: 10.71079/aside.im.0000012282413. Epub 2024 Dec 28.
Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United States (US).
We performed a retrospective analysis using the TriNetX US Collaborative Network database (1990-2024). We investigated demographic characteristics, time-based trends, geographic distribution, treatment pathway patterns, comorbidity profiles, and associated risks with IIH. We used multivariate regression, Cox proportional hazards modeling, and standardized morbidity ratios to assess various outcomes and associations.
Among 51,526 patients, we found a significant increase in adult IIH incidence from 16.0 per 100,000 in 1990-1999 to 127.0 per 100,000 in 2020-2024 (adjusted RR: 6.94, 95% CI: 6.71-7.17). Female predominance increased over time (female-to-male ratio: 3.29, 95% CI: 3.18-3.40). Southern regions showed the highest prevalence (43.0%, n=21,417). During the 2020-2024 period, initial medical management success rates varied between acetazolamide (42.3%) and topiramate (28.7%). Advanced interventional procedures showed 82.5% success rates in refractory cases during the same timeframe. Cox modeling for the entire study period (1990-2024) revealed significant associations between IIH and metabolic syndrome (HR: 2.14, 95% CI: 1.89-2.39) and cardiovascular complications (HR: 1.76, 95% CI: 1.58-1.94), independent of Body Mass Index.
Our findings highlight IIH as a systemic disorder with significant metabolic implications beyond its neurological manifestations. The marked regional disparities and rising incidence rates, especially among adults, suggest the need for targeted healthcare strategies. Early intervention success strongly predicts favorable outcomes, supporting prompt diagnosis and treatment initiation. These results advocate for an integrated approach combining traditional IIH management with broad metabolic screening care.
随着人口结构模式的变化，特发性颅内高压（IIH）带来的健康负担日益加重。我们通过在美国进行的大规模数据库分析，研究了IIH的全国流行病学趋势、治疗模式及相关结果。
我们使用TriNetX美国协作网络数据库（1990 - 2024年）进行回顾性分析。我们调查了IIH的人口统计学特征、基于时间的趋势、地理分布、治疗途径模式、合并症概况及相关风险。我们使用多变量回归、Cox比例风险模型和标准化发病率来评估各种结果及关联。
在51526名患者中，我们发现成人IIH发病率从1990 - 1999年的每10万人16.0例显著增加到2020 - 2024年的每10万人127.0例（调整后RR：6.94，95%CI：6.71 - 7.17）。女性优势随时间增加（女性与男性比例：3.29，95%CI：3.18 - 3.40）。南部地区患病率最高（43.0%，n = 21417）。在2020 - 2024年期间，乙酰唑胺的初始药物治疗成功率为42.3%，托吡酯为28.7%。在同一时间段内，难治性病例的高级介入手术成功率为82.5%。对整个研究期间（1990 - 2024年）进行的Cox建模显示，IIH与代谢综合征（HR：2.14，95%CI：1.89 - 2.39）和心血管并发症（HR：1.76，95%CI：1.58 - 1.94）之间存在显著关联，与体重指数无关。
我们的研究结果突出表明IIH是一种全身性疾病，除神经表现外还具有重大代谢影响。明显的地区差异和发病率上升，尤其是在成年人中，表明需要有针对性的医疗保健策略。早期干预成功强烈预示着良好的结果，支持及时诊断和开始治疗。这些结果主张采用一种将传统IIH管理与广泛的代谢筛查护理相结合的综合方法。
