The authors analysed cross-sectional data with the aim of exploring the social determinants of idiopathic intracranial hypertension (IIH). The data was obtained from the National Institute of Health (NIH) All of Us research programme (version 6 – May 2018 to January 2022), which recruited 1 million residents from the US. Females between 18–50 years of age were identified and spilt by diagnosis of IIH or not. The following information was extracted from the records: employment status, constraints accessing healthcare, annual income, ethnicity, body mass index (BMI) and weight. Logistical regression was used to analyse the data. A total of 416 individuals with IIH and 107,111 individuals without IIH met the inclusion criteria. Women with a diagnosis of IIH were found to have a higher BMI, in keeping with the known epidemiology. They were also more likely to be non-Hispanic Black or African American than those without a diagnosis of IIH. This association reduces when income and CMI are adjusted for, suggesting ethnic disparity is driven by social economic status (SES) risk factors for obesity. Those with a diagnosis of IIH were more likely to be unemployed and have a lower annual income, in unadjusted logistic regression. They were also more likely to delay access to healthcare due to living in a rural area, difficulties with transport and for financial reasons in models with and without adjustment. The authors acknowledge some findings are likely to reflect known associations between lower SES and obesity. The identified delay in seeking healthcare could result in preventable vision loss. Several study limitations are acknowledged including the use of predominantly self-reported data, potential for misdiagnosis of IIH within the cohort and the lack of longitudinal data. Future studies should explore the impact of the social determinants identified by this study on visual outcomes and weight loss.
Identification of potential social determinants which may impact on idiopathic intracranial hypertension
Reviewed by Lauren Hepworth
Social determinants of health in idiopathic intracranial hypertension.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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