Social Determinants of Health in Spasticity Toxin Treatment

Background and/or Objectives: Social determinants of health (SDoH) are personal, social, and environmental factors that impact a patient’s health, functioning, and quality of life. Access to care in marginalized populations is an obstacle to appropriate spasticity management. Due to limited research available on the influence of SDoH in spasticity, we analyzed the association between patients’ demographic and SDoH-related characteristics and toxin treatment utilization.

Design: Retrospective claims-based cohort analysis

Setting : PurpleLabs HealthNexusTM US medical and pharmacy open claims database

Participants : Patients >18 years old with ≥1 spasticity diagnosis between October 1, 2016 and December 31, 2022, and ≥12 months of continuous enrollment (pharmacy and medical) pre/post diagnosis

Interventions: Not applicable

Main Outcome Measures: Demographic and SDoH-related characteristics stratified by treated vs non-treated patients with toxin

Results: Most spasticity-diagnosed patients (N=254,322) were White, female, had a high school education as their highest degree, had commercial insurance, and an annual income of ≥$40k. Of those, 3,240 (1.3%) received toxin treatment for spasticity. Males were 26% more likely compared to females (p < 0.01), Asian patients were 39% more likely compared to White patients (p < 0.01), and patients with a higher education were more likely to receive toxin treatment. Older patients had lower likelihoods of receiving toxin treatment compared to patients < 55 years old (p < 0.05). Additionally, patients with a household income of >$100k had a higher likelihood of receiving toxin treatment compared with <$40k (p < 0.01), and patients with Medicare or Medicaid were more likely compared with commercial insurance (p < 0.01) to receive toxin treatment.

Conclusions: A large proportion of the US spasticity patient population has not received toxin treatment. Race, education, and healthcare coverage significantly contribute to the likelihood of receiving toxin for spasticity. Elevating awareness on the variations of SDoHs and their association with received treatments may help to improve spasticity management and outcomes.