Objective:

To characterize the impact of health insurance type on time to evaluation by a spontaneous intracranial hypotension (SIH) specialist for patients with SIH.

Background:

SIH, or spinal cerebrospinal fluid leak, is a frequently underdiagnosed and misdiagnosed disorder characterized by orthostatic headache. The impact of insurance type on patient access to SIH specialists has not yet been investigated.

Design/Methods:

This is a sub-analysis of a retrospective, IRB-approved chart review (IRB #22D.519) that assessed migraine prevalence in SIH patients evaluated by an SIH specialist at a tertiary headache center. Electronic medical records of 41 patients, aged ≥18, from January 1, 2021 to September 1, 2023, were analyzed. Eligibility was determined by confirmed or probable SIH diagnosis based on Schievink 2011 criteria with at least one follow-up visit. Records were evaluated for patient demographics, employment status, insurance type, date of symptom onset, and date of presentation to SIH specialist.

Results:

Among the 30 patients who met inclusion criteria, the average age was 45.0±13.6 years, with a 1.3:1 female-to-male ratio. 93.3% were Caucasian, 3.3% were Asian-American/Pacific Islander, and 3.3% were non-Caucasian Hispanic/Latinx; 13.3% were on disability, 63.3% were working, and 13.3% were students. Publicly insured patients (23.3% of patients) had a longer average time to presentation to an SIH specialist compared to privately insured patients (76.7% of patients, 4.75±4.62 years vs. 1.53±2.05 years, p = 0.033). Patients had similar average follow-up encounters within an 18 month follow-up timeframe (3.14±1.07 for publicly insured vs 3.13±0.97 visits for privately insured, p = 0.977).

Conclusions:

Public insurance is associated with a significantly longer time to evaluation by an SIH specialist compared to private insurance.  However, there is no significant difference in number of specialist follow-up visits based on insurance type. Further investigation into how socioeconomic barriers impact diagnosis and management in this rare condition is warranted.