SOCIAL DISPARITIES IN HEALTHCARE UTILIZATION FOR CHILDREN AND ADOLESCENTS WITH MIGRAINE DISEASE

Headache disorders are very common among youth but remain underdiagnosed and undertreated especially in emergency department (ED) where providers must worry about serious causes of headache. This disproportionately affects patients from marginalized communities who tend to visit the ED for chronic conditions. While prior research found disparities in migraine treatment, we suspect that these disparities might also involve migraine diagnosis. If so, the biases one aims to explore may also lead to selection bias for studies that identify patients by diagnosis. Migraine care also faces obstacles unique to headache especially relating to patient-provider communication. In this thesis, we looked at nationwide trends in racial/ethnic disparities in headache management in pediatric EDs. As we found migraine was underdiagnosed for children from marginalized groups, we developed several language-learning models to identify migraine independent of diagnostic coding. We explored which patient traits were associated with the thoroughness of clinical documentation. Amongst patients with model-identified migraine, we explored socioeconomic trends in migraine care during and after the ED visit. Continuing on to outpatient care, we explored the feasibility of adopting a text message-based headache diary. Using diary-collected data, we determined the level of agreement between participants’ self-reported migraine attacks and attacks determined by diagnostic criteria. In the nationwide study, Non-Hispanic Black (NHB) children diagnosed with headache in the ED received fewer migraine-specific diagnoses and lower rates of testing, neuroimaging, and intravenous medications. At our institution, we found that boys and younger patients tended to have less thorough clinical notes. However, notes were sufficient to train several models to identify migraine. For children with model-identified migraine, we again found that NHB children received less intensive care and fewer migraine diagnoses even after accounting for potential confounders. For the text message-based diary, participants displayed high completion rates; however, participants tended to underestimate which headaches were actually migraine attacks. Overall, these findings suggest that there are significant barriers to migraine care that are felt disproportionately by children from marginalized communities.

Author dc:creator

• Kellier, Danielle, Joy

Advisors dc:contributor.advisor

• Farrar, John, T
• Szperka, Christina, L

• Life Sciences
• Bioinformatics

Language dc:language.iso

en

Repository record dc:identifier.uri

https://repository.upenn.edu/handle/20.500.14332/62745

OAI identifier oai:identifier

oai:repository.upenn.edu:20.500.14332/62745