NASHVILLE, Tenn. ― Hospitalizations for prolonged, life-threatening seizures ― called status epilepticus ― have risen steadily, and Black patients are twice as likely to be affected as white patients, suggests an analysis of national data being presented at the American Epilepsy Society Annual Meeting.
Researchers analyzed 486,861 hospitalizations for status epilepticus from the Nationwide Inpatient Sample from 2010 to 2019, and found the numbers increased significantly over that period, especially among minorities. They also determined minority patients were more likely to require advanced treatments, including a tube placed in the neck (tracheostomy) to help with breathing and a feeding tube placed in the stomach (gastrostomy).
“It was disturbing to see that disparities in the frequency of status epilepticus for minorities have not only persisted but widened over 10 years, despite a greater awareness of the condition as well as improvements in insurance coverage,” said Gabriela Tantillo, M.D., M.P.H., lead author of the study and assistant professor of neurology at Baylor College of Medicine, Houston. “For cases of status epilepticus that are potentially preventable, such as undiagnosed epilepsy, improving health literacy and reducing the stigma associated with seizures would help more patients get the treatment they need.”
The researchers determined the rate of status epilepticus hospitalizations nearly doubled from 2010 to 2019, from 10 to 24 per 10,000 hospital admissions (patients hospitalized for any reason), and that it was higher among minority patients than white patients. The rate of hospitalization for status epilepticus per 10,000 admissions among non-Hispanic Black patients (27.3) was nearly double that of white patients (13.7). The rate for other minority patients was also higher compared to white patients: 15.8 among Hispanic patients and 16.1 among non-Hispanic minority patients, including Asian, Pacific Islander and Native American.
Minority patients also were more likely to have tracheostomy and gastrostomy procedures, which typically are performed in patients with more critical disease. The need may reflect severe status epilepticus or underlying medical injury, Dr. Tantillo noted. Compared to white patients: Black patients had 71% higher adjusted odds of tracheostomy and 78% higher adjusted odds of gastrostomy; and Hispanic patients had 22% higher adjusted odds of tracheostomy and 37% higher adjusted odds of gastrostomy.
Additionally, the odds of receiving brain-wave testing (electroencephalogram, or EEG monitoring) rose with the patient’s income level. EEG monitoring may be less accessible outside of hospitals that offer higher levels of specialized care, which may reflect disparities in care based on income or insurance status, but more research is needed, Dr. Tantillo noted.
However, minority patients were less likely to die, as were those in the highest income quartile, researchers found. “One potential reason might be that the underlying cause of status epilepticus might differ among minority groups,” said Dr. Tantillo. “For example, status epilepticus related to low antiseizure medication levels are associated with better survival than other causes, such as a catastrophic brain bleed or lack of oxygen to the brain.”