Social disparities in healthcare utilization for children and adolescents with migraine disease Danielle Kellier

Format:

Book

Thesis/Dissertation

Author/Creator:

Kellier, Danielle, author.

Contributor:

University of Pennsylvania. Epidemiology and Biostatistics., degree granting institution.

Language:

English

Subjects (All):

Epidemiology.

Bioinformatics.

Public health.

Pediatrics.

0766.

0715.

0767.

0769.

0573.

Local Subjects:

Epidemiology.

Bioinformatics.

Public health.

Pediatrics.

0766.

0715.

0767.

0769.

0573.

Genre:

Academic theses

Physical Description:

1 online resource (286 pages)

Contained In:

Dissertations Abstracts International 87-12B

Place of Publication:

Ann Arbor : ProQuest Dissertations and Theses, 2026

Language Note:

English

Summary:

Headache disorders are very common among youth but remain underdiagnosed and undertreated especially in emergency department (ED) where providers must worry about serious causes of headache. This disproportionately affects patients from marginalized communities who tend to visit the ED for chronic conditions. While prior research found disparities in migraine treatment, we suspect that these disparities might also involve migraine diagnosis. If so, the biases one aims to explore may also lead to selection bias for studies that identify patients by diagnosis. Migraine care also faces obstacles unique to headache especially relating to patient-provider communication. In this thesis, we looked at nationwide trends in racial/ethnic disparities in headache management in pediatric EDs. As we found migraine was underdiagnosed for children from marginalized groups, we developed several language-learning models to identify migraine independent of diagnostic coding. We explored which patient traits were associated with the thoroughness of clinical documentation. Amongst patients with model-identified migraine, we explored socioeconomic trends in migraine care during and after the ED visit. Continuing on to outpatient care, we explored the feasibility of adopting a text message-based headache diary. Using diary-collected data, we determined the level of agreement between participants' self-reported migraine attacks and attacks determined by diagnostic criteria. In the nationwide study, Non-Hispanic Black (NHB) children diagnosed with headache in the ED received fewer migraine-specific diagnoses and lower rates of testing, neuroimaging, and intravenous medications. At our institution, we found that boys and younger patients tended to have less thorough clinical notes. However, notes were sufficient to train several models to identify migraine. For children with model-identified migraine, we again found that NHB children received less intensive care and fewer migraine diagnoses even after accounting for potential confounders. For the text message-based diary, participants displayed high completion rates; however, participants tended to underestimate which headaches were actually migraine attacks. Overall, these findings suggest that there are significant barriers to migraine care that are felt disproportionately by children from marginalized communities

Notes:

Source: Dissertations Abstracts International, Volume: 87-12, Section: B.

Advisors: Farrar, John T.; Szperka, Christina L. Committee members: Holmes, John H.; Boland, Mary Regina; Hubbard, Rebecca A.; Charleston, Larry, IV

Ph.D. University of Pennsylvania 2026

Vendor supplied data

Local Notes:

School code: 0175

ISBN:

9798247979210

Access Restriction:

Restricted for use by site license