Social determinants of health, clinical outcomes, and healthcare resource utilization in participants with and without narcolepsy in the All of Us research program
Abstract
Abstract Study Objectives Evaluate the clinical and economic burden and impact of social determinants of health (SDoH) in narcolepsy. Materials and Methods This retrospective, observational study used electronic health record and survey data from the All of Us Research Program (1/1/2009–7/31/2022). Participants with narcolepsy were matched 1:3 to participants without narcolepsy. Descriptive statistics and regression analyses (odds ratios [ORs]) summarized demographics, clinical comorbidities, and SDoH; hazard ratios (HRs) estimated risk of incident hypertension, hyperlipidemia, obesity, and coronary arteriosclerosis (CA); and incidence rate ratios (IRRs) estimated healthcare resource utilization (HCRU). Results The sample comprised 2766 participants (narcolepsy, n = 694; non-narcolepsy, n = 2072; mean age, 49 years; 70 per cent female). Despite high education levels, greater proportions were out of work/the workforce in the narcolepsy versus non-narcolepsy cohort (38.5 per cent vs. 29.2 per cent). Among SDoH survey respondents, greater food insecurity, loneliness, and everyday/medical discrimination, and less social support/cohesion were reported in the narcolepsy (n = 259) versus non-narcolepsy (n = 768) cohort. Individuals with versus without narcolepsy had higher odds (OR [95 per cent confidence interval; CI]) of cardiovascular (1.76 [1.35–2.28]), cardiometabolic (2.12 [1.73–2.59]), and renal (2.47 [1.72–3.56]) comorbidities; higher risk (HR [95 per cent CI]) of developing hypertension (2.00 [1.51–2.65]), hyperlipidemia (1.96 [1.52–2.54]), obesity (2.42 [1.93–3.05]), and CA (1.75 [1.27–2.42]); and increased HCRU (IRR [95 per cent CI]) for inpatient days (2.07 [1.55–2.78]), outpatient visits (1.51 [1.35–1.70]), and emergency department visits (1.70 [1.19–2.43]). Conclusions Narcolepsy is associated with employment barriers, SDoH-related disparities, and elevated comorbidity burden and risk. Comprehensive and timely management strategies are needed to address whole-person health.