(108) Comparing the Association of Social Determinants of Health between Hypertension, Migraine, and Coexisting Hypertension and Migraine in U.S. Adults Using Medical Expenditure Panel Survey Data (2013-2019)

Background: Understanding the interplay between interrelated conditions, such as hypertension and migraine, alongside social determinants of health (SDoH) is critical for identifying at-risk populations.

Objectives: Our study explores the association between SDoH and hypertension (HTN), migraine, and coexisting conditions of hypertension and migraine (CC) in U.S. adults.

Methods: A retrospective cross-sectional study was conducted using Medical Expenditure Panel Survey (MEPS) 2013-2019 data. Adults aged 18-65 years with HTN, migraine, or CC were included. Chi-square was performed for categorical SDoH variables, and ANOVA was performed for the continuous SDoH variables. We further performed multinomial logistic regression analyses comparing CC vs. migraine, CC vs. HTN, and migraine vs. HTN. We used PROC SURVEY functions for weighted results.

Results: Our weighted cohort comprised of 84% HTN, 12% migraine, and 3% CC patients. The comparison across categories (HTN vs. Migraine Vs. CC) revealed that patients with migraine were significantly younger, females (47% vs. 84% vs.75%), non-Hispanic Whites (NHW) (63% vs 75% vs 71%), have an education level of a college degree or above (48% vs 61% vs 53%) and have private insurance (71% vs 77% vs 67%), p-value=0.001. There was a significant difference in average personal and family income between groups (p-value=0.025 and p=0.007, respectively), with the highest average income in patients with migraine, followed by HTN, and the lowest in the CC group. The distribution of conditions across regions was significantly different (p-value < 0.001), with the number of migraine patients significantly higher in the West (19% vs. 26% vs. 14%), HTN patients significantly higher in the South (44% vs. 32% vs. 38%), and patients with CC were significantly higher in Midwest (22% vs. 23% vs. 27%). A significantly higher number of patients with CC had food stamp usage (15% vs. 14% vs. 22%, p-value=0.001) and had a CCI score of ≥3 (3.3% vs. 1.0% vs. 4.2%, p-value < 0.001). After adjusting using multinomial logistic regression, males had lower odds of migraine vs. HTN (OR: 0.129, 95% CI: 0.106-0.158) but higher odds of coexisting conditions (OR: 3.705, 95% CI: 2.771-4.952). An increase in age was associated with HTN and CC (OR: 0.357, 95% CI: 0.331-0.385; OR: 1.471, 95% CI: 1.297-1.669, respectively). Non-Hispanic blacks had higher odds of HTN (OR: 1.602, 95% CI: 1.144-2.244) and CC (OR: 1.921, 95% CI: 1.402-2.632) but lower odds of migraine (OR: 0.53, 95% CI: 0.365-0.771).

Conclusions: Our study highlights the importance of considering SDoH to identify at-risk populations of hypertension and migraine. Targeted interventions addressing these social determinants could be crucial in reducing disparities in the screening and management of these conditions.