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Published on: June 2, 2014
The Role of Income and Health Insurance on Migraine Care: Results of the OVERCOME (US) Study
Richard B Lipton1,2, Betzaida Martinez3, Dawn C Buse1
1Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
Introduction:
Using data from the OVERCOME study, we examined the influence of household income on access to specialty care and use of recommended acute and preventive treatments for migraine in a large population-based study.
Methods:
This analysis from the OVERCOME study, a multicohort, web-based survey (2018-2020) among adults with migraine in the US, examined the influence of annual household income on (1) care-seeking, (2) the highest level of care received (emergency department/urgent care, primary care, specialty care), and (3) use of acute or preventive treatments recommended by the American Headache Society. We used standardized mean differences and logistic regression (LR) models to estimate the magnitude of differences in health care behavior as a function of household income and insurance status.
Results:
Among OVERCOME (US) respondents with migraine who provided demographic information (n = 56,667), a higher proportion of people in the lowest income group (< $25,000) received their highest level of migraine care in the emergency department/urgent care setting versus the proportion in the highest income group [≥ $100,000: 12.3% vs 6.5%, standardized mean difference (SMD) = 0.20], and a greater proportion in the highest income group received care in a specialty headache care setting (48.6% vs 36.6% in the lowest income group, SMD = 0.24). The highest income group was more likely to receive a recommended acute treatment [odds ratio (OR) = 1.3, 95% confidence interval (CI) = (1.2, 1.4)] and a recommended preventive treatment [OR = 1.3, 95% CI = (1.2, 1.4)]. Those with health insurance were more likely to receive specialized care [OR = 2.6, 95% CI = (2.4, 2.8)] and recommended acute [OR = 1.9, 95% CI = (1.8, 2.0)] and preventive treatment [OR = 2.1, 95% CI = (1.9, 2.3)]. The effect of insurance was greatest in low-income strata and was not significant in the highest household income group.
Conclusion:
Disparities in annual household income may be a barrier to appropriate migraine care, but having health insurance mitigates the effect.
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