Inpatient and Emergency Department Epidemiology and Differences Across Health Disparity Populations in People with Functional Neurological Disorders
Christopher Stephen1, Vicki Fung2, Codrin Lungu4, David Perez3, Alberto Espay5
1Department of Neurology, 2Health Policy Research Center, Mongan Institute, 3Department of Neurology and Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 4Pfizer, inc, 5Department of Neurology, University of Cincinnati
Objective:

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

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.

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.

10.1212/WNL.0000000000206173