Authors :
Gabriela Tantillo, MD, MPH – Baylor College of Medicine; Deepa Dongarwar, MS – Data Scientist, UT McGovern School of Medicine; Chethan Venkatasubba Rao, MD – Associate Professor of Neurology, Neurology, Baylor College of Medicine; Amari Johnson, BA – Medical student, Baylor College of Medicine; Stephanie Camey, BA – Post-baccalaureate student, Baylor College of Medicine; Oriana Reyes, BA – Post-baccalaureate student, Baylor College of Medicine; Mariana De Pary Baroni, BA – Medical student, Baylor College of Medicine; Jaideep Kapur, MD, PhD – Professor of Neurology, Neurology, University of Virginia College of Medicine; Hamisu Salihu, MD, PhD – Professor, Center of Excellence in Health Equity, Training & Research, Baylor College of Medicine; Nathalie Jette, MD – Professor of Neurology, Neurology, Icahn School of Medicine at Mount Sinai
This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session
Rationale: Status epilepticus (SE) is associated with high rates of morbidity and mortality. While disparities have been described in epilepsy care, their contribution to SE and associated outcomes remain understudied.
Methods: We used the 2010-2019 Nationwide Inpatient Sample data to identify hospitalizations with SE using ICD-9-CM/ICD-10-CM codes. SE prevalence was calculated and stratified by demographics. Logistic regression assessed factors associated with electroencephalography, intubation, tracheostomy, gastrostomy, and mortality.
Results: There were 486,861 SE hospitalizations from 2010-2019, primarily at urban teaching hospitals (71.3%). SE prevalence (calculated per 10,000 hospital admissions) from highest to lowest was 27.3 for Non-Hispanic (NH) Blacks, 16.1 for NH-others, 15.8 for Hispanics, and 13.7 for NH-Whites (p < 0.01). SE prevalence was higher in the lowest income quartile compared to the highest (18.7 vs. 14; p< 0.01). Rising age was associated with intubation, tracheostomy, gastrostomy and in-hospital mortality in a dose-dependent manner. The population aged ≥80 had a particularly high risk of morbidity and mortality with the highest odds of intubation (OR 1.5, CI =1.43-1.58), tracheostomy (OR 2, CI=1.75-2.27), gastrostomy (OR 3.37, CI=2.97-3.83) and in-hospital mortality (OR 6.51, CI=5.95-7.13), compared to the reference group (age 18-39). Minority populations (Hispanics, NH-Blacks and NH-Others) had higher odds of tracheostomy and gastrostomy compared to NH-Whites. NH-Blacks had the highest odds of tracheostomy (OR 1.71, CI=1.57-1.86) and gastrostomy (OR 1.78, CI=1.65-1.92). The odds of receiving EEG monitoring rose progressively with rising income quartile (OR 1.47, CI=1.34-1.62, for the highest income quartile) and were higher in urban teaching compared to rural hospitals (OR 12.72, CI 8.92-18.14). Odds of mortality were lower (compared to NH-Whites) in Hispanics (OR 0.82, CI=0.76-0.89), NH-Blacks (OR 0.71, CI=0.67-0.75) and for the highest income quartiles (OR 0.9, CI=0.84-0.97).
Conclusions: Disparities exist in SE prevalence, tracheostomy and gastrostomy in patients with SE across age, race/ethnicity, and income. Older age and lower income are additionally associated with mortality. Access to EEG monitoring is modulated by income and access to urban teaching hospitals. Older adults, racial/ethnic minorities, and populations of lower income or rural location may represent vulnerable populations meriting increased attention in order to improve health outcomes and advance health equity.