The prevalence of idiopathic intracranial hypertension (IIH) is drastically superior in black and Hispanic women compared to people of other races and ethnicities, according to new research.
The researchers found that IIH was nearly 3.5 times more common in black women and 2 times more common in Hispanic women, a phenomenon that is probably explained by a combination of socioeconomic factors rather than race or ethnicity.
“Although previous studies have shown differences in IIH between different races, ours is the first to identify the association between socioeconomic determinants of health and the prevalence of IIH,” Venkatesh L researched. Brahma, MD, a neuroophthalmologist in Jersey City, New Jersey, said Medscape Medical News.
The conclusions were published online May 12 Neurology.
Lack of access to healthy food
Obesity is the leading risk factor for IIH, which occurs most frequently in women of childbearing potential. The researchers noted that socioeconomic and environmental factors affect the risk of obesity and minority communities are more likely to have lower incomes and / or restricted access to healthy foods.
To clarify the relationship between geographic and socioeconomic variables and IIH prevalence, the researchers conducted a retrospective cohort study at a single center in Philadelphia.
They examined the electronic health records of women who visited a neuroophthalmologist on an outpatient basis between January 1, 2010 and July 1, 2018.
Among this group, researchers identified women with IIH or papilloma. Women without IIH who were 50 years of age or younger served as a control group. Information was also collected on demographic data, including age, race, ethnicity, insurance status, weight, and body mass index (BMI).
In addition, the researchers used the U.S. Census Bureau’s geocoding program to convert patients ’addresses to U.S. census zones.
Based on publicly available data from agencies such as the U.S. Department of Agriculture and the Centers for Disease Control and Prevention, the researchers identified census tracts with little access to healthy food (defined as food desserts). and those with a high proportion of bad food (defined as food swamps).
A total of 223 women with HDI (mean age, 29 years; mean BMI, 37.4) and 4783 women without IIH (mean age, 40 years; mean BMI, 26.1) were included in the analysis.
Obesity, IIH clearly linked
The results showed that a higher proportion of women with IIH (52.9%) was black or Hispanic compared to the control group (22.9%). The majority of patients with IIH lived in low-income census areas (51.1%) and 20.6% had Medicaid insurance.
After adjusting for age, women with IIH were approximately four times more likely to be black (risk probability [OR], 3.96) and approximately twice as likely to be Hispanic (OR, 2.23) and to live in low-income census areas (OR, 2.24) or food swamps (OR, 1.54). However, they were less likely than women without IIH to live in a food desert (OR, 0.61).
After adjusting for race, ethnicity, and Medicaid status, patients with IIH were even more likely to be black (OR, 3.45) or Hispanic (OR, 2.01).
However, the association between census tract characteristics and IIH was no longer statistically significant. When the researchers adjusted for BMI, the association between the black race and the IIH remained significant (OR, 2.26).
“While our study shows that women with IIH in our institution were more likely to be black or Hispanic, there are likely to be many factors for this association,” Brahma said. Further clarification is needed to clarify the relationship between race, ethnicity and IIH, he added.
However, the association between obesity and the prevalence of IIH is already clear.
“More recently, studies have also identified relationships between obesity and socioeconomic factors,” such as income level and access to healthy foods, Brahma said.
“Our study appears to identify similar relationships between socioeconomic factors and IIH prevalence,” he noted.
Need for risk mitigation strategies
Commenting on the findings of Medscape Medical News, Kathleen B. Digre, MD, head of the division of Headache and Neuroophthalmology, University of Utah, Salt Lake City, said the large, well-controlled study asked key questions about the social determinants of health.
“Such studies that examine social determinants are really important because we know they have a direct effect on our health, but it is rarely reported,” said Digre, who was not involved in the research.
However, the retrospective design of the study is a weakness and, since the population was limited to the Philadelphia area, the results may not be generalizable elsewhere, he noted.
“We’ve always known that there can be a racial and ethnic difference in IIH, so that doesn’t surprise me,” Digre said. “Obesity levels tend to increase in these groups, and the fact that it’s harder to get fresh fruits and vegetables also makes it difficult.”
The economic level of the population also plays a role indicating that the burden of IIH is partially related to disparities and access to better nutrition, he added.
“Neurologists should be aware of food swamps and inform patients about diet in IIH,” Digre said. The findings also show that environmental social factors may contribute to obesity, he noted.
One question for future research is whether other social determinants of health can be addressed to reduce the effect of IIH on quality of life and mitigate disparities.
“If access to fresh fruits and vegetables were taken to food swamps, could that change the diet and weight of the community?” Digre asked.
The study was funded by the National Institutes of Health. Brahma and Digre have not reported any relevant financial relationships.
Neurology. Published online May 12, 2021. Summary