Abstracts

Rationale: Medicaid beneficiaries, who represent the lowest socio-economic stratum of the US population, suffer from disabling physical and/or mental ailments. They have been found to have substantially high incidence and prevalence of epilepsy. Epilepsy is associated with numerous comorbidities, which can complicate diagnosis and/or have adverse prognostic implications. In order to accurately assess the burden of epilepsy, the data on comorbid conditions are critically needed. To date, very few studies, if any, have examined the burden of comorbidities among Medicaid beneficiaries with epilepsy. The aim of this study was to examine the patterns of comorbidities in adult Medicaid beneficiaries with and without epilepsy.Methods: We used the 2005-2008 Ohio Medicaid Analytic Extract (MAX) data for this cross sectional study. Our study population included beneficiaries aged 18-64, who were not enrolled in the managed care program or Medicare program, and, did not have a period of spend down. We measured the prevalence of 45 common comorbid conditions that were selected based on their commonality in persons with epilepsy (PWE) and, compared them to that of adults without epilepsy in the cohort, using prevalence ratios (PR) and 95% confidence interval (CI).Results: Among the 232,898medicaid beneficiaries from 2005 to 2008, we identified 6,140 prevalent cases of epilepsy. The age distribution of PWE was similar to that of people without epilepsy. Compared to persons without epilepsy, PWE had significantly higher prevalence of chronic conditions, particularly benign brain tumor (PR=22.9, 95% CI (15.5, 33.9)), developmental disorder (PR=19.6, 95%CI (18.8, 20.4)), dementia (PR=19.4, 95%CI (17.4, 21.5)), traumatic brain injury (PR=19.2, 95%CI (16.9, 21.8)), intracranial hemorrhage (PR=18.7, 95%CI (15.7, 22.3)), osteoporosis (PR=15.4, 95%CI (14.0, 18.5)), brain cancer (PR=15.4, 95%CI (12.6, 18.9)), sleep disorders (PR=15.1, 95%CI (9.0, 25.3)) and ischemic stroke (PR=14.2, 95%CI (13.0, 15.5)). Similarly, the prevalence of schizophrenia (PR=7.4, 95%CI (6.9, 8.0)), bipolar disorder (PR=5.5, 95%CI (5.2, 6)), anxiety disorder (PR=4.1, 95%CI (3.8, 4.5)), attention deficit disorder (PR=4.1, 95%CI (3.4, 4.9)) and depressive disorder (PR=4.0, 95%CI (3.8, 4.2)) were also significantly higher in PWE.Conclusions: Medicaid beneficiaries with epilepsy have substantially high prevalence of chronic comorbid conditions than those without epilepsy. This indigent population carries a disproportionate amount of the burden from both epilepsy and its comorbidities. A comprehensive plan including prevention, identification and adequate treatment for these comorbidities need to be integrated into epilepsy management at all levels of care