(194) Social Determinants of Health and Migraine Management: A Real-World Analysis Using the Area Deprivation Index

Background: : Migraines are a leading cause of disability worldwide, yet many face barriers to effective care. Social determinants of health, including socioeconomic status, geographic location, and healthcare access, may influence treatment patterns and patient outcomes. Recent advances such as calcitonin gene related peptide (CGRP) inhibitors have improved clinical outcomes, yet their higher cost creates barriers to equitable patient access. Limited access to CGRPs among disadvantaged populations may increase reliance on urgent care, emergency department services, and opioid usage, driving higher overall healthcare costs. The Area Deprivation Index (ADI) allows stratification by socioeconomic disadvantage to identify disparities in migraine therapy use and related health outcomes.

Objective: : To assess the relationship between ADI level and utilization of CGRPs, triptans, and other migraine therapies to evaluate disparities in access, adherence, and healthcare utilization across ADI tiers in a managed care population.

Methods: : from January 1, 2023 to December 31, 2024. Members ≥18 years with a migraine diagnosis (ICD-10 G43.*) or ≥1 claim for a migraine-specific medication, continuous enrollment during the study, and residence in a four-state area were included. Of 57,564 members identified, 1,452 were excluded for incomplete ZIP codes and 1,898 for missing ADI data, yielding a final cohort of 54,214. The ADI, ranging from 1 (least disadvantaged) to 10 (most), was grouped into tertiles: Tier 1 (1–3), Tier 2 (4–7), and Tier 3 (8–10). Endpoints included: 1) use of CGRPs, triptans, and other migraine therapies by tier; 2) CGRP-to-triptan ratio; 3) proportion without migraine treatment; 4) pharmacy claim burden; 5) opioid/NSAID use; and 6) migraine-related ED/UC visits. Descriptive statistics compared utilization across tiers.

Results: : Preliminary descriptive analysis of the 54,214 member cohort indicates lower CGRP use and higher reliance on triptans and opioids in Tier 3 compared with Tier 1. Additionally, there was an increase in ED/UC visit rates among Tier 3 members. Final results will be presented at the 2025 Nexus Meeting.

Conclusions: : Preliminary findings suggest socioeconomic disadvantage, as measured by ADI, is associated with reduced CGRP use and increased acute care utilization in migraine patients. Understanding these disparities may inform value-based contracting, prior authorization policy, and targeted interventions to improve access and reduce downstream healthcare costs.

Sponsorship:: None