Objective:

To determine the impact of social determinants of health (SDOH) on clinical outcomes in pediatric anti-NMDA Receptor Encephalitis (pNMDARE).

Background:

pNMDARE is one of the most common autoimmune encephalitis in the pediatric population and can vary in degrees of severity and long-term outcomes. Epidemiologic studies suggest that race and ethnicity impact pNMDARE incidence; however, further characterization of health disparity risk factors impacting disease outcomes is unknown.

Design/Methods:

We conducted a retrospective cohort study using electronic health records of pNMDARE between January 2007 and November 2022 at a tertiary children’s hospital. Area Deprivation Index (ADI) and Childhood Opportunity Index (COI) were used as aggregated measures of SDOH. Outcomes included hospital length of stay (LOS), ICU admission, and treatment with plasma exchange (PLEX) as proxies for disease severity, and modified Rankin Scores (mRS) at 1 year as a proxy for disease prognostication. We employed Spearman’s rank correlation and multivariable linear/ordinal regression models to assess correlations and associations between ADI/COI and clinical outcomes.

Results:

A total of 22 participants (mean 12.75±4.35, 72.7% female) were included in this study. National ADI scores ranged from 5-100 (median 19, IQR 9-47), and National COI scores ranged from 2-92 (median 40.5, IQR 6.3-78): 40.9% were in “Very Low” (<20%) National COI scores. ADI and COI were moderately correlated with each other (p = 0.01). No association was found between ADI/COI and hospital LOS (p = 0.50), ICU admission (p = 0.78), and the use of PLEX (p = 0.88). No association was found between ADI/COI and mRS at 1 year (p = 0.31).

Conclusions:

A higher proportion of pNMDARE patients come from socioeconomically disadvantaged areas at time of disease presentation. There is no association between ADI/COI and measures of disease severity and prognostication. Further research is needed to validate these findings and determine the impact of SDOH on other pNMDARE outcomes.