Abstract TP376: Association of Neighborhood Socioeconomic Status with Hospitalizations and Emergency Department Visits in Patients with Familial Cerebral Cavernous Malformations

Introduction: Cerebral cavernous malformations (CCM) can rupture causing life-threatening hemorrhagic stroke or acute neurological symptoms from seizures or deficits, necessitating urgent medical care. Disparities at the individual and neighborhood levels may contribute to delays in primary health care utilization and poorer health outcomes. We hypothesized that neighborhood socioeconomic status (SES) would be associated with CCM-related hospitalizations and emergency department (ED) visits in patients with familial CCM. Methods: Among 130 familial CCM patients enrolled in a longitudinal cohort study at our institution, 100 were California residents with valid addresses and demographic information. We used state-specific Area Deprivation Index (ADI), a validated decile measure utilizing census block group variables (income, education, employment, housing) to quantify neighborhood SES disadvantage. Higher ADI decile indicates greater disadvantage. We used multivariable Poisson regression to test for associations between ADI and lifetime cumulative counts of CCM-related hospitalizations and ED visits and report Incidence Rate Ratios (IRR); we adjusted for sex, non-White race, prior hemorrhage, and prior seizure. Results: Mean age of the cohort was 44.7 ± 18.5 years, 58% were female, 34% were Non-White ethnicity, 37% had a history of hemorrhage, and 47% had a history of seizures. Mean CA State ADI was 4.98 (range 1–10). A total of 58% had at least 1 ED visit (range 0–6), and 48% had at least 1 hospitalization (range 0–4). We found that ADI was significantly associated with hospitalizations and ED visits. After adjustments, for each increase in ADI, there was a 12% increase in rate of hospitalizations (IRR=1.12, 95% CI: 1.04–1.21, p=0.004) and a 7% increase in rate of ED visits (IRR=1.07, 95% CI: 1.01–1.14, p=0.019). Conclusions: Patients with familial CCM residing in higher neighborhood disadvantaged areas had increased rates of hospitalizations and ED visits, even after adjusting for individual-level characteristics. Further studies are needed to better understand reasons underlying this association, which may inform interventions to reduce urgent care visits.