Associations Between Neighborhood-level Indices and Clinical Outcomes in Pediatric Anti-NMDA Receptor Encephalitis (pNMDARE)
Jennifer Yang1, Alice Yu2, Alexander Sandweiss3, Kristen Fisher3, Ilana Kahn4, Alexandra Kornbluh4, Katerina Nastea4, Ryan Kammeyer5, Amy Young5, Jennifer Koop6, Lileth Mondok6, Leigh Sepeta4
1University of California San Diego, 2Johns Hopkins University, 3Baylor College of Medicine, 4Children's National Hospital, 5Childrens Hospital Colorado, 6Medical College of Wisconsin
Objective:
To determine the associations between neighborhood-level indices and clinical outcomes in pNMDARE.
Background:
Epidemiologic studies show that pNMDARE has a higher incidence in non-White populations. However, further characterization of health disparity risk factors impacting disease outcomes are unknown.
Design/Methods:
We conducted a multi-center retrospective cohort study of pNMDARE from 2007-2022 at 5 geographically diverse tertiary children’s hospitals. Neighborhood-level indices included Area Deprivation Index (ADI) national percentiles (1-100) and state deciles (1-10), and Childhood Opportunity Index (COI) normed scores (1-100) and quintiles (1-20 “Very Low”; 21-40 “Low”; 41-50 “Moderate”; 51-80 “High”; 81-100 “Very High”) and domains (Education [ED], Health and Environment [HE]), Socioeconomic [SE]). Outcomes included hospitalization duration, EEG and MRI abnormalities, ICU admission, immunotherapy, and modified Rankin Scores (mRS) at admission and 1 year. We employed univariate Wilcoxon ranked sum test to compare disadvantaged (1-40) vs. non-disadvantaged (41-100) COI groups and multivariable linear regression modeling adjusting for age of onset and sex to determine associations between ADI/COI and clinical outcomes.
Results:
We included 200 participants (median age of onset 12.6 years, IQR 5.9 – 15.0, 64% female) in the analysis; 43.5% identified as White Hispanic, 14.5% White Non-Hispanic, 42% Non-White. Median composite national COI score was low (33.0, IQR 12.5-67.0): 57% composite, 52% ED, 68% HE and 54% SE domains were in “Very Low” or “Low” quintiles. mRS at admission was significantly different between disadvantaged vs non-disadvantaged groups for composite COI (p=0.04) and COI HE (p=0.009). Higher deprivation (high ADI, p=0.005, low COI, p=0.004) was associated with higher mRS at admission but not 1 year mRS. There were no associations between ADI/COI and other clinical variables.
Conclusions:
A high proportion of pNMDARE patients are Non-White or Hispanic aligning with prior data. More than half come from disadvantaged neighborhoods based on COI with higher mRS at presentation suggesting a disparity in disease expression.
Generative AI Usage
No, did not use generative AI in the drafting or editing in this abstract.
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