SUN-834 - The Impact of Socioeconomic Deprivation and Neuropsychiatric Comorbidities on Myxedema Coma: A National Analysis

Background: Myxedema coma (MC) is a rare, life-threatening emergency representing the most severe presentation of hypothyroidism. Structural, nutritional, and neuropsychiatric vulnerabilities may contribute to decompensation. We examined whether these factors are independently associated with MC development and clinical outcomes.

Methods: We used the 2022 Nationwide Readmissions Database for adult hospitalizations with a diagnosis of hypothyroidism. Variables were identified using ICD-10-CM. Three vulnerability domains were evaluated: socioeconomic, nutritional, and neuropsychiatric. Survey-weighted multivariable logistic regression identified independent predictors of MC and in-hospital outcomes. Readmissions and length of stay were also analyzed.

Results: Among an estimated 4.2 million adults with hypothyroidism, 3,675 presented with MC. Compared with the general hypothyroid population, MC patients were younger (66.7 vs 69.2 years, p< 0.001), more often in the lowest income quartile (40% vs 30%, p< 0.001), and more frequently insured by Medicaid (20% vs 10%, p< 0.001). In adjusted models, malnutrition (aOR 2.94), uninsured status (aOR 2.50), and homelessness (aOR 2.13) were the strongest predictors of developing MC. A weight-dependent association was observed, with obesity class I–II not associated with MC, while morbid obesity (class III) independently increased risk (aOR 1.64, p< 0.001). Among neuropsychiatric conditions, schizophrenia (aOR 1.54) and dementia (aOR 1.84) increased MC risk, whereas anxiety was associated with lower odds (aOR 0.56, p< 0.001). Depression and Bipolar disorder did not show any significance. The overall in-hospital mortality rate among MC patients was 20.7%. After multivariable adjustment, uninsured status (aOR 3.33, p=0.009) and malnutrition (aOR 1.42, p=0.028) remained independent predictors of mortality. Conversely, schizophrenia was associated with a paradoxical survival advantage (aOR 0.28, p=0.009). Most readmissions were driven by non-thyroid causes, and recurrent MC was rare, accounting for < 1% of readmissions. Medicaid insurance was associated with prolonged length of stay (+3.5 days, p=0.02) while patients in the highest income quartile incurred significantly higher hospital charges (+$59,430, p=0.01).

Conclusion: Myxedema coma is strongly associated with socioeconomic deprivation, nutritional imbalance, and select neuropsychiatric comorbidities among adults with hypothyroidism. Structural barriers such as lack of insurance, housing instability, malnutrition, and morbid obesity appear to play a central role in precipitating severe thyroid decompensation. These findings frame myxedema coma as a condition shaped by intersecting social, nutritional, and cognitive factors and underscore the need for prevention strategies beyond inpatient endocrine management.

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