Abstract Details

Title Inpatient and Emergency Department Epidemiology and Differences Across Health Disparity Populations in People with Functional Neurological Disorders

Topic Health Care Disparities

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-014

Background

FND have high costs and healthcare utilization, comparable with investigation/pharmacologically-intensive neurological disorders. There are scant reports on the epidemiology of FND and related disparities.

Objective

To assess inpatient and emergency department (ED) epidemiology and healthcare disparities in functional neurological disorder (FND) in adults and children.

Design/Methods

We used 2019 data from large federal healthcare databases to assess adult (age >18) and pediatric (5-17 years) inpatient hospitalizations and adult/pediatric ED visits. ICD-10-CM codes for functional neurological symptom disorder (F.44.4-F44.7) defined FND and its subgroups. We assessed differences in discharge disposition by age, sex, race/ethnicity, ZIP code income quartile, urban/rural residence, and insurance type, and differences in healthcare utilization, patient charges, and inpatient length of stay within FND/subgroups.

Results

In adult FND hospitalizations, females vs. males (65.95% vs. 56.98%) and Native American (73.77%) and Hispanic (65.78%) vs. White (63.69%) FND patients were more commonly discharged home; patients in the highest (57.87%) ZIP code income quartile were less likely discharged home vs. the lowest quartile (64.52%), all p<0.01. In pediatric FND hospitalizations, White patients were more commonly discharged home (p=0.0004), while discharge disposition was otherwise similar between groups.

In adult ED presentations, FND patients >65 years (16.49%) were less likely discharged home vs. 18-40 years (61.67%), p<0.0001. In pediatric ED presentations, FND in the lowest ZIP code income quartile were most commonly discharged home (72.12%) vs. the highest (63.45%), p<0.0001.

Functional attacks/seizures were the most common FND subtype, followed by motor FND (movement/weakness). In adults, race was similar across subtypes but in children, motor FND was more racially diverse. Length of stay and per patient charges in adult/pediatric FND admissions were higher in older age, males, highest zip code income quartile, urban settings, and differed by race (highest in Asians) and FND subtype.

Conclusions

We found age, sex, race and income differences in FND and its subtypes.

Authors/Disclosures
Christopher D. Stephen, MBBS, MB ChB, FRCP, SM (Massachusetts General Hospital) PRESENTER	Dr. Stephen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SwanBio Therapeutics. The institution of Dr. Stephen has received research support from Sanofi. Dr. Stephen has received research support from National Institutes of Health.
Vicki Fung	No disclosure on file
Codrin I. Lungu, MD, FAAN	Dr. Lungu has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier, inc..
David L. Perez, MD, FAAN (Massachusetts General Hospital)	Dr. Perez has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley: Brain and Behavior. The institution of Dr. Perez has received research support from NIH. The institution of Dr. Perez has received research support from Sidney R. Baer Jr. Foundation. Dr. Perez has received publishing royalties from a publication relating to health care.
Alberto J. Espay, MD, FAAN (University of Cincinnati)	Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neuroderm. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avion. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acadia. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acorda. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyowa Kirin. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sunovion. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Herantis Pharma. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Supernus (formerly USWorldMeds). Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acadia. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Synaps Dx. Dr. Espay has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AskBio. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Supernus (formerly, USWorldMeds). Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Amneal. Dr. Espay has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Avion Pharmaceuticals. The institution of Dr. Espay has received research support from NIH. The institution of Dr. Espay has received research support from Michael J Fox Foundation for Parkinson's Research. Dr. Espay has received intellectual property interests from a discovery or technology relating to health care. Dr. Espay has received publishing royalties from a publication relating to health care. Dr. Espay has received publishing royalties from a publication relating to health care. Dr. Espay has received publishing royalties from a publication relating to health care.