Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data.

Autor:	Tang SH; Drexel University College of Medicine, Philadelphia, Pennsylvania., Min J; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Zhang X; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Uwah E; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Griffis HM; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Cielo CM; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Fiks AG; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Mindell JA; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.; Miller School of Medicine, University of Miami, Miami, Florida., Tapia IE; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.; Miller School of Medicine, University of Miami, Miami, Florida., Williamson AA; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.; The Ballmer Institute, University of Oregon, Portland, Oregon.
Jazyk:	angličtina
Zdroj:	Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine [J Clin Sleep Med] 2024 Jul 01; Vol. 20 (7), pp. 1141-1151.
DOI:	10.5664/jcsm.11104
Abstrakt:	Study Objectives: The purpose of this study was to characterize the incidence of pediatric narcolepsy diagnosis, subsequent care, and potential sociodemographic disparities in a large US claims database. Methods: Merative MarketScan insurance claims (n = 12,394,902) were used to identify youth (6-17 years of age) newly diagnosed with narcolepsy ( International Classification of Diseases, 10th revision codes). Narcolepsy diagnosis and care 1 year postdiagnosis included polysomnography with Multiple Sleep Latency Test, pharmacological care, and clinical visits. Potential disparities were examined by insurance coverage and child race and ethnicity (Medicaid-insured only). Results: The incidence of narcolepsy diagnosis was 10:100,000, primarily type 2 (69.9%). Most diagnoses occurred in adolescents with no sex differences, but higher rates in Black vs White youth with Medicaid. Two thirds had a prior sleep disorder diagnosis and 21-36% had other co-occurring diagnoses. Only half (46.6%) had polysomnography with Multiple Sleep Latency Test (± 1 year postdiagnosis). Specialty care (18.9% pulmonary, 26.9% neurology) and behavioral health visits were rare (34.4%), although half were prescribed stimulant medications (51.0%). Medicaid-insured were 86% less likely than commercially insured youth to have any clinical care and 33% less likely to have polysomnography with Multiple Sleep Latency Test. Conclusions: Narcolepsy diagnoses occurred in 0.01% of youth, primarily during adolescence, and at higher rates for Black vs White children with Medicaid. Only half overall had evidence of a diagnostically required polysomnography with Multiple Sleep Latency Test, underscoring potential misdiagnosis. Many patients had co-occurring conditions, but specialty and behavioral health care were limited. Results suggest misdiagnosis, underdiagnosis, and limited narcolepsy treatment, as well as possible disparities. Results highlight the need to identify determinants of evidence-based pediatric narcolepsy diagnosis and management. Citation: Tang SH, Min J, Zhang X, et al. Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data. J Clin Sleep Med . 2024;20(7):1141-1151. (© 2024 American Academy of Sleep Medicine.)
Databáze:	MEDLINE
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