Disparities in the symptomatic presentation of Moyamoya disease in the United States: A nationwide all-payer analysis


      • MMD is a cerebrovascular disease manifesting with ischemic or hemorrhagic symptoms.
      • This disease is mainly studied in Asian populations due to its high prevalence.
      • In the US, presentations of MMD are associated with patient age, gender, and race.



      Moyamoya disease is a chronic occlusive cerebrovascular disease that can present with either hemorrhagic or ischemic symptoms. The objective of this study was to evaluate whether the symptomatology of Moyamoya disease differs according to patient demographic groups.


      In this study, we used the Nationwide Inpatient Sample (NIS) to investigate differences in the presentation of Moyamoya disease by age group, gender, and ethnicity from 2012 to 2016. After propensity score matching was utilized to control for overall comorbidity, the matched cohorts for each symptomatology were compared using a Chi-square test with respect to the potential risk factors of interest (i.e. age, sex, ethnicity) in order to generate multivariate reported P-values.


      A total of 4,474 patients met inclusion criteria. Patients presenting with ischemic stroke were more likely to be 65 years and older (p < 0.001); patients presenting with intracranial hemorrhage (ICH) were more likely to be 65 years and older (p < 0.001), male (p = 0.027), and Asian (p = 0.007); those presenting with seizure were more likely to be less than 10 years old (p = 0.002) and African American (p < 0.001); and those presenting with headache were more likely to be between 10 and 19 years old (p = 0.008).


      Our findings demonstrate that the distinct presentations of Moyamoya are associated with patient age, gender, and race. This is the largest study of its kind and adds to the collective understanding of this rare but life-threatening condition.



      ICD-9-CM (International Classification of Disease 9th edition Clinical Modification), ICD-10-CM (International Classification of Diseases 10th edition Clinical Modification), ICH (Intracranial hemorrhage), MMD (Moyamoya disease), NIS (Nationwide Inpatient Sample), TIA (Transient ischemic attack)
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