Abstracts

Rationale:
Inequities continue to persist within the United States healthcare system, particularly by race/ethnicity and socioeconomic status. Lacking health insurance coverage greatly limits available treatment options at comprehensive epilepsy centers, which include inpatient video-EEG monitoring and epilepsy surgery. Ongoing surveillance of these services is critical to ensure quality epilepsy care among underserved populations.
Method:
We analyzed data from the New Jersey Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) from 2014-2016, which includes all adult admissions to general hospitals statewide. From this database, we identified elective admissions for video-EEG monitoring with an admitting diagnosis ICD-9 or ICD-10 code for seizure (780.3; R56.9) or epilepsy (345; G40) and excluded all admissions coded for intracranial EEG placement. We calculated descriptive statistics by demographic characteristics (age, race/ethnicity, sex), length of stay, and primary payer for adults under age 65. Using data from the Census and the American Community Survey, we determined elective video-EEG admission rates among the state population by race/ethnicity and primary payer with associated Poisson 95% confidence intervals to assess whether admission rates differed significantly between groups. We used the Holm-Bonferroni method to correct for multiple comparisons.
Results:
There were 2429 adult (age > 18) admissions for elective video-EEG monitoring for seizure or epilepsy in New Jersey over the three-year period between 2014-2016. Admitted patients had a mean age of 41.1 years (SD 16.9, range 18-94). Women comprised 57.0% of admissions. The mean length of stay was 3.6 days (SD 2.5). Table 1 summarizes the number of elective video-EEG admissions by racial group and expected payer source, as well as statewide admission rates. Primary payer status was determined for adults under age 65 (n = 2181 admissions).  Admission rates were highest among Black patients (p< 0.0001), followed by Whites and Hispanics. Asian/Pacific Islanders were least likely to utilize this service (p< 0.0001). Among adults under age 65, the highest rate of elective video-EEG admissions was noted for those with Medicare as the primary payer, followed by Medicaid, private insurance, and lastly lowest for self-pay/no charge patients. Rate differences by insurance coverage were statistically significant between all groups (p< 0.0001).