(P-569) Comorbidities Associated with Insomnia Stratified by Age and Sex

Background: Few large studies have examined the association of comorbidities with an insomnia diagnosis stratified by age and gender.

Objectives: To identify comorbidities associated with an insomnia diagnosis by age and gender groups.

Methods: We employed a matched case-control study using IBM MarketScan claims database 2017-2018 including patients with 2-year continuous enrollment and at least one medical encounter. Insomnia cases were patients with at least two outpatient claims or one inpatient claim of insomnia (ICD-10-CM codes: G47.0x, F51.0x). Controls were 1:1 matched to cases by exact age and sex. Patients were stratified to 6 groups by age (<= 17, 18-64 and >=65) and gender (male/female). We pre-specified 76 conditions (based on 2 outpatient claims or 1 inpatient claim) and included them in the conditional logistic regression with stepwise selection (significance level of entry: 0.05; significance level of stay: 0.01) to identify conditions associated with insomnia within each age-gender group.

Results: A total of 304,606 insomnia cases were identified with boys being the smallest group (n=5,399), and adult females the largest (n=167,746). Preliminary results from conditional logistic regression models showed that among boys, depression, anxiety, autism, and ADHD were significantly associated with insomnia (ORs range: 4.1-8.8); among girls, epilepsy, migraine, cluster headache, bipolar disorder, adjustment disorder, back pain, constipation, heartburn were additionally significantly associated with insomnia (ORs range: 2.1-7.0). In adults, besides the above-mentioned conditions, many conditions (such as substance abuse, Parkinson’s disease, fibromyalgia, ORs range: 1.3-2.5) were also associated with insomnia. Men and women shared many conditions, but the ORs were usually smaller among women. In men, erectile dysfunction and benign prostatic hyperplasia were also associated with insomnia. In older adults, conditions associated with insomnia were like those in adults; however, the ORs were even smaller. In older men, only depression, anxiety, bipolar disorder, cluster headache had OR > =2, in older women only anxiety had OR >=2.

Conclusions: Many comorbidities are associated with insomnia, and they differed by age and gender. Some mental conditions were significant across all age and sex groups. Girls had more conditions associated with insomnia than boys, but no apparent gender difference found among adults (except for the conditions specific to men). Adults had more conditions associated with insomnia than children, but associations were less strong. These results may inform the integrated management of the insomnia.