Migraine care for American Indians linked to age, language, residency

Key takeaways:

• American Indians were less likely than white individuals to receive migraine diagnosis or treatment.Age, knowledge of English and location were mitigating factors in this patient population.

SAN DIEGO —American Indians are less likely to receive a migraine diagnosis or migraine treatment compared with their white counterparts due to a variety of socioeconomic factors, according to a poster.

“The goal of this research is to see if there is any health disparities, specifically within the population of American Indians, and we have a unique opportunity to look into that within Arizona because we have a very large American Indian population as well as many reservations,” Jessalyn Shen, MD, a neurologist in the division of headache medicine, Mayo Clinic, told Healio at the American Academy of Neurology Annual Meeting. “The unique snapshot we get in Arizona is what we wanted to look at specifically in migraine and migraine diagnosis.”

Their population-based study examined records of individuals from the Arizona Health Care Cost Containment System. Approximately 8% of those covered in the system identify as American Indian.

For initial screening, Shen and colleagues included more than 1 million individuals aged 3 years or older with an enrollment gap of no more than 45 days a year between 2018 and 2020.

Two cohorts were created: patients aged 3 to 17 years and patients aged 18 years and older The cohorts were further subdivided into two additional categories: diagnosis of migraine and diagnosis of headache.

“There’s a little bit of hesitancy in being able to get on the ground within those reservations,” Shen said regarding the usage of claims data, rather than patient interviews, as the basis of the study. “There’s maybe a little distrust with the health system.”

Shen and colleagues defined the headache cohort as those who recorded at least one inpatient or ED claim leading to headache diagnosis; at least two outpatient headache diagnoses and no claims to either a migraine diagnosis as well as no pharmacy claim for triptans or ergots.

They defined the migraine cohort as those who recorded at least one inpatient ED claim with migraine diagnosis; at least two outpatient claims with migraine diagnosis or at least one claim with migraine diagnosis, at least one pharmacy claim with triptans or ergots, or at least two pharmacy claims with triptans or ergots.

The final analysis included 70 individuals aged 3 to 17 years and 678 aged 18 years and older who received migraine-specific treatment.

Shen and colleagues additionally analyzed factors such as demographics, comorbidities and other social issues, while utilizing multivariate logistic models to determine odds ratios for comparison of migraine diagnosis and treatment for American Indians compared with white individuals.

According to results, the likelihood of American Indians to receive a diagnosis of migraine was lower compared with white individuals both in the pediatric population (OR = 0.65; 95% CI: 0.59-0.71) and among adults (OR = 0.6; 95% CI: 0.58-0.62).

Additionally, the likelihood was lower for American Indians compared with white counterparts for receiving migraine-specific treatments in children (OR = 0.76; 95% CI: 0.59-0.99) and adults (OR = 0.5; 95% CI: 0.46-0.55).

Shen and colleagues also reported that migraine diagnosis increased in the pediatric American Indian population aged 6 to 17 years and in adults aged 25 to 44 years, before a decrease in diagnosis in adults aged 55 to 85 years and older.

The researchers also found that speaking a primary language other than English was associated with decreased rates of migraine diagnosis in American Indian adults (OR = 0.58; 95% CI, 0.44-0.77), with the reverse true for younger people (OR = 1.84; 95% CI, 1.07-3.17).

Finally, data showed that living in urban areas increased migraine diagnosis and treatment rates, particularly in the pediatric population (OR = 1.33; 95% CI, 1.08-1.64) compared with the adult population (OR = 1.15; 95% CI, 1.07-1.24).

“We wanted to look at if there were any specific health disparities, specific variables that are influencing (migraine diagnosis),” Shen told Healio. “When you look at the coding, you see things like comorbidities ... structural kinds of health issues like having housing or having access to different resources, that has also influenced the frequency and the rate of both diagnosis and treatment.”

For more information:

Jessalyn Shen, MD, can be reached at Shen.Jessalyn@mayo.edu