(71) Healthcare resource use and clinical burden in narcolepsy: An analysis of the All of Us research program

Background: : Narcolepsy is a central disorder of hypersomnolence primarily characterized by excessive daytime sleepiness. While the clinical burden of narcolepsy is known, key social determinants of health (SDoH) and the economic burden remain poorly understood.

Objective: : To describe healthcare resource utilization (HCRU) and comorbidity burden among US individuals with narcolepsy, overall and stratified by household income (HHI).

Methods: : A retrospective, observational study analyzed electronic health record (EHR) and survey data from the All of Us research program. Individuals with narcolepsy were identified using SNOMED codes (1/1/2009–1/31/2022). Non-narcolepsy participants were matched 3:1 to those with narcolepsy at index (earliest narcolepsy diagnosis date) on age, sex, earliest EHR encounter, time in EHR, and SDoH survey completion. Regression models estimated adjusted incidence rate ratios (IRRs) and odds ratios (ORs) with 95% confidence intervals (CIs) for HCRU (reported per patient per month [PPPM]) and comorbidities over baseline and follow-up periods, overall and by HHI ( <$50k, ≥$50k).

Results: : In total, 2766 participants (narcolepsy: n=694; non-narcolepsy: n=2072) were identified (mean age: 49 years; 70% female). In unadjusted analyses among those with HCRU >0, individuals with vs without narcolepsy had higher mean (standard deviation) numbers of inpatient days (IP; 0.25 [0.55] vs 0.14 [0.23]), outpatient visits (OP; 1.34 [1.84] vs 0.77 [1.16]), and emergency department visits (ED; 0.21 [0.36] vs 0.15 [0.30]) PPPM. Similar trends were observed when stratified by HHI. In adjusted models, those with vs without narcolepsy had higher IRRs (95% CI) for IP days (2.07 [1.55, 2.78]) and OP (1.51 [1.35, 1.70]) and ED visits (1.70 [1.19, 2.43]) in baseline, as well as in follow-up. Higher proportions of those with vs without narcolepsy had cardiometabolic (CM) comorbidities, particularly among the lower HHI group (hyperlipidemia: <$50k: 34.0% vs 24.7%; ≥$50k: 32.8% vs 28.4%; obesity: <$50k: 38.0% vs 23.5%; ≥$50k: 22.7% vs 16.7%). The associations between narcolepsy and any CM comorbidity and obesity were stronger among the lower vs higher income groups (OR [95% CI]: any CM comorbidity: <$50k: 2.29 [1.70, 3.10]; ≥$50k: 1.69 [1.21, 2.34]; obesity: <$50k: 2.09 [1.54, 2.83]; ≥$50k: 1.52 [1.05, 2.20]).

Conclusions: : Narcolepsy is associated with a higher economic and comorbidity burden, which is exacerbated by socioeconomic disparities. Earlier or more intensive interventions may be warranted to improve outcomes, particularly among lower-income individuals.

Sponsorship:: Jazz Pharmaceuticals