Social Determinants of Health in Newly Diagnosed Hereditary Angioedema and Their Impact on Healthcare Resource Utilization Outcomes.

Abstract

Hereditary angioedema (HAE) is a rare disease characterized by unpredictable, painful swelling attacks. Social determinants of health may affect healthcare resource utilization (HCRU) for HAE attacks. Estimate HCRU among patients with HAE analyzed by race and ethnicity, household income, and rural/urban residency. This retrospective, observational study used healthcare insurance claims data (January 1, 2016, to September 30, 2023) from Inovalon's closed claims database. Eligible patients had a new HAE diagnosis or treatment claim (first claim defined index date), no previous claim in previous 12 months' continuous health plan enrollment, maintained 24-month continuous enrollment post-index, and were not using angiotensin-converting enzyme inhibitors. Multivariable models and HAE-related HCRU data revealed that patients from lower-income households (<$50,000 annually) had a higher risk of emergency department (ED) visits (risk ratio, 1.44; 95% confidence interval [95% CI], 1.23-1.68), but no difference in hospitalization risk (1.07; 95% CI, 0.69-1.65) versus those from higher-income households. Black patients had a higher risk of HAE-related ED visit (risk ratio, 1.50; 95% CI, 1.27-1.76), more ED visits (rate ratio, 2.33; 95% CI, 1.74-3.13), and higher hospitalization rates (2.25; 95% CI, 1.10-4.57) versus White patients. ED visit rate ratios were higher for Hispanic/Latino versus White patients (1.71; 95% CI, 1.16-2.50). Rural versus urban residency did not significantly affect HAE-related HCRU. Allergist/immunologist care access was lower among Black patients (16.7%) and among those from lower-income households (25.5%) versus the overall study population (27.5%). Among patients with HAE, disparities exist in HCRU. Targeted strategies are essential for ensuring equitable access and improving outcomes for underserved patients.