Understanding the Impact of Sex and Race on the Migraine Patient’s Journey in the United States: Analyses From an Annual Cross-Sectional Patient Chart Audit
Robert Cowan1, Meg Stabb2, Nicholas Robinson2, Virginia Schobel2
1Stanford Neurosciences Health Center, 2Spherix Global Insights
Objective:
To determine whether subgroup disparities recognized in general society are reflected in subpopulations with migraine.
Background:
It has been widely observed that disparities exist between various sub-groups in the U.S., including commonly noted disparities based on sex and race.
Design/Methods:
In May/June 2020, 230 US physicians contributed chart review data for 1,003 patients recently prescribed a calcitonin gene-related peptide monoclonal antibody or onabotulinumtoxinA. Subgroups were defined by sex (female n=710; male n=293) and race (Caucasian [n=765] or minority [African-American, Latino/Hispanic, Asian, other; n=238]).
Results:

Females were younger at first migraine episode (22.7 vs. 29.1 years) and diagnosis (26.1 vs. 32.0 years) than males; Caucasians were younger than minorities at both events. More males are managed by migraine specialists (52% vs. 36%), especially minority males (56%) versus white females (35%). Minorities, especially minority females, were more likely covered by Medicaid (15% vs. 7%). More females were diagnosed with chronic migraine (41% vs. 24%), while more males were diagnosed with low frequency episodic migraine (28% vs. 16%). Comorbid hypertension was more common among males (21% vs. 13%) and minorities (21% vs. 13%), with highest rates among Caucasian males (23%) and minority females (24%). Females were more often diagnosed with anxiety (17% vs. 8%) and depression (27% vs. 21%).

Whereas 68% of females had previously failed ≥2 previous preventive therapies, 51% of males had failed one preventive therapy and were more likely to have recently been prescribed fremanezumab (22% vs. 17%) or eptinezumab (9% vs. 5%). Patient request (32% vs. 24%), efficacy onset speed expectation (29% vs. 22%), family planning consideration (12% vs. 3%), and non-adherence concern (11% vs. 5%) more often influenced therapy selection among minority patients.

Conclusions:
Subgroup disparities reported for the general US population exist and are even more significant in the migraine community. Stakeholders in migraine care should acknowledge and address these disparities.