Idiopathic intracranial hypertension more common in Black, Hispanic women
Idiopathic intracranial hypertension occurred more often in Black and Hispanic women compared with white women, according to findings from a retrospective case-control study published in Neurology.
The trend persisted after accounting for "the demographics of a modern city,” the researchers noted. The findings suggested that part of this relationship is driven by the correlation between obesity, the primary risk factor for idiopathic intracranial hypertension (IIH), and rates of IIH with lower income and “food swamps,” or neighborhoods with more high-calorie fast food and “junk” food options.
“We found that women with IIH were more than twice as likely to be Black than people who did not have the condition, even after we adjusted for their BMI, so we believe that racial differences are not explained solely by obesity,” Venkatesh L. Brahma, MD, of the division of neuro-ophthalmology, departments of neurology and ophthalmology, at the University of Pennsylvania, said in a press release.
Brahma and colleagues at the University of Pennsylvania sought to assess the relationship between IIH and socioeconomic determinants of health, including low-income status and proximity to healthy food.
The retrospective, case-controlled study included adult female patients who had an outpatient visit with a neuro-ophthalmologist at the University of Pennsylvania between January 1, 2010, and July 1, 2018. Brahma and colleagues included patients with a diagnosis code for IIH as well as an order for a lumbar puncture. The researchers converted patients’ street address information into tracts according to 2010 U.S. census data to assess income and food access, specifically looking at tracts with limited access to healthy food (“food deserts”) or those with a greater number of unhealthy to healthy food options (“food swamps”). They used logistic regression to compare the proportion of patients with IIH to those without IIH, adjusting for age, race/ethnicity, BMI, Medicaid coverage as a proxy for socioeconomic status and neighborhood characteristics, including low-income census tracts and proximity to food deserts or swamps.
The study included 223 adult women with IIH (median age, 29 years) and 4,783 adult women without IIH (median age, 40 years). The group of women with IIH included similar rates of white (48.4%) and Black (47.1%) women, with fewer Hispanic women (4.5%), while the group of women without IIH included mostly white women (77%) and fewer Black women (20%) and Hispanic women (2.9%). The cohort of women with IIH included 20.6% on Medicaid, 51.1% from a low-income area, 28.3% in a low food access area and 48.1% in a “food swamp” area. Among the patients without IIH, 9.8% were on Medicaid, 31.1% were in a low-income area, 40.1% were in a low food access area and 35.8% were in a “food swamp” area.
After adjusting for age, Brahma and colleagues found that women with IIH were more likely to be Black (OR, 3.96; 95% CI, 2.98-5.25), Hispanic (OR, 2.23; 95% CI, 1.14-4.36) and living in low-income (OR, 2.24; 95 % CI, 1.71-2.95) or food swamp areas (OR, 1.54; 95% CI, 1.15-2.07). In addition, patients with IIH were less likely to live in food deserts than controls (OR, 0.61, 95% CI, 0.45-0.83).
After adjusting again for race, ethnicity and Medicaid status, the researchers found that women with IIH were still more likely to be Black (OR, 3.45; 95% CI, 2.45-4.87) or Hispanic (OR, 2.01; 95% CI, 1.01-4), although the correlation between census tract and IIH no longer reached statistical significance. The association between Black women and IIH remained significant after adjusting for BMI (OR, 2.261; 95% CI, 1.53-3.34).
“Our results provide some support for racial disparities that can be seen in this condition,” Brahma said in the press release. “Though at least some of this relationship is driven by the link between obesity and idiopathic intracranial hypertension with low-income neighborhoods and food swamps, it does not fully explain the differences, and other systemic health disparities are likely involved.”
He also highlighted the need for further research in this area.
“Additional studies are needed to help us understand the link between race, ethnicity, access to healthy foods, exposure to unhealthy foods, other social determinants of health and idiopathic intracranial hypertension,” Brahma said. “Our findings suggest that multiple factors are likely involved.”
Reference:
American Academy of Neurology. Who is affected by brain pressure disorder the most? Available at: https://www.aan.com/PressRoom/Home/PressRelease/4893. Accessed May 12, 2021