Abstracts

Rationale: People with epilepsy have a high risk of premature death. Racial/ethnic disparities exist in the points of care and outcomes associated with epilepsy. Socioeconomic factors and not biological/genetic differences appear to be mostly responsible for the ethnic/racial disparities in the outcome of epilepsy. The goal of Healthy People 2010 is to eliminate health disparities, including differences that occur by gender, race or ethnicity, education or geographic location. The first step towards eliminating racial/ethnic disparities in health is to identify high risk population and causes of disparities. The primary aim of this study is to identify statewide differences in epilepsy related mortality and correlate with ethnic/racial disparities. This may help with resource allocation towards potentially avoidable epilepsy related deaths. Methods: The target population for the study comprised individuals who had died from an epilepsy-related death, in the state of Arizona, between 2007 and 2009. Data were collected from Arizona Vital Statistics, Department of Health Services. Statistical analysis was done with SPSS 18.0. Geo-epidemiological mapping was performed to highlight differences in mortality at county level. The state of Arizona comprises of 15 counties. Results: During the 3 year study period, there were 176 deaths reported with epilepsy/status epilepticus as the immediate or underlying cause of death. Among the 176 deaths 97(57%) were female. The racial breakdown consists of: 116 (65%) non-Hispanic whites, 39 (22%) Hispanics/Latinos, 11(6.2%) American Indians, 6 (3.4%) African Americans, and 4 (2.3%) Asians/ Pacific inlanders . The mean age at death was 54 years (SD =25.82) and it varied between counties with minimum of 24 years (SD=20.6) (Mohave County) and maximum of 73 years (SD=2.83) (Apache County). Racial/ethnic disparity in mean age of death was noted among Hispanics (Mean=40 years, SD = 19.23); non Hispanic whites (Mean= 55 years, SD = 25.46) and American Indians (Mean= 49 years,SD =27.54). The proportionate mortality rate of epilepsy in the state of Arizona in 2007-2008 was 0.123% (parts of the 2009 data required for the PMR calculation were not available). Assuming the prevalence of epilepsy as 5 per 1,000; the calculated mortality rate was 2.06 per 1,000 patient-years. Causes of epilepsy related deaths were: status epilepticus (N=80;45%); SUDEP (N=5; 3%); direct epilepsy related (N= 6; 3.5%); accidents as a consequence of seizures (N=13; 8%) and suicide (N=2; 1%). Drowning was reported in 3 patients; thermal injuries in 2 patients and motor vehicle accident in 3 patients. Among the 176 deaths 8 (4.5%) were residing at the reservation and 22 (12.5%) were military veterans. Compared to Whites, the Hispanics had higher prevalence of cardiovascular disease. Conclusions: Racial/ethnic disparity in mortality among epileptic patients is present in different counties of Arizona. Mean age at death among Hispanics and American Indians is younger compared to non-Hispanic whites. This study identifies counties with maximum racial/ethnic disparity in mortality.