Authors :
Presenting Author: Siran Koroukian, PhD, M.S.N., M.H.A. – Case Western Reserve University
Hannah Fein, MS, MPH – Health Services Research Analyst, Population and Quantitative Health Sciences, Case Western Reserve University; Long Vu, MS – Health Services Research Analyst, Population and Quantitative Health Sciences, Case Western Reserve University; Wyatt Bensken, Ph.D. – Research Investigator Science Programs, OCHIN, Inc.; Nicholas Schiltz, Ph.D. – Assistant Professor, School of Nursing, Case Western Reserve University; Martha Sajatovic, MD, MS – Professor of Psychiatry and of Neurology, Case Western Reserve University; Gena Ghearing, MD – Clinical Associate Professor, University of Iowa; David Warner, Ph.D. – Associate Professor, Sociology, University of Alabama, Birmingham
Rationale:
Epilepsy incidence increases with age, and so does the prevalence of chronic conditions, further complicating the management of epilepsy in older adults. Prior studies have examined the presence of chronic conditions in older adults with prevalent epilepsy, but few have done so among those with incident epilepsy. Identifying the conditions with which older adults with incident epilepsy present assists with the evaluation of burden of illness in this patient population and informs the development of coordinated care. The objectives of our study were: 1) to identify chronic conditions with excess prevalence in older adults with incident epilepsy compared to that of their counterparts without epilepsy; and 2) to examine variations in chronic disease prevalence by race/ethnicity. Methods:
This cross-sectional study used data from the 2018-2019 Medicare Beneficiary Summary File (MBSF) with chronic conditions and behavioral risk factors for a sample of 4,999,999 Medicare beneficiaries receiving their care through the traditional fee-for-service system. Non-Hispanic Black (NHB) and Hispanic beneficiaries were oversampled. Our main outcome measures consisted of adjusted prevalence ratios (APRs) for chronic conditions in older adults with incident epilepsy, compared to those without epilepsy. To determine whether minoritized beneficiaries with incident epilepsy had higher odds than their non-Hispanic White (NHW) counterparts of presenting with a certain chronic condition, we also produced age- and sex-adjusted odds ratios (aORs). Chronic conditions were identified in the MBSF years prior to epilepsy diagnosis.
Results:
Our study population included 19,631 with incident epilepsy. We observed excess prevalence for most chronic conditions in older adults with epilepsy. For stroke, for example, the APR was 5.44 (99% CI:5.23-5.65), meaning that the prevalence of stroke was 5.44 times higher among individuals with incident epilepsy than without. Similarly, prevalence was higher for neurological conditions (APR:4.22 [3.95-4.51]); mental illness (APR:2.67 [2.52-2.84]); substance use disorders (APR:3.17 [2.86-3.52]); alcohol and tobacco use disorders (APR: 3.63 [3.37-3.90]) and APR: 2.04 (1.95-2.13), respectively)—to name a few. In examining variations by race/ethnicity, we observed that Hispanic beneficiaries with incident epilepsy had markedly higher odds of having been diagnosed with chronic conditions than their NHW counterparts, particularly for metabolic conditions (aOR:2.05 [1.61-2.60]) and cardiovascular disease (aOR:1.68 [1.40-2.03]). Differences in chronic disease prevalence between NHB and NHW beneficiaries with incident epilepsy were less pronounced.
Conclusions:
Compared to older adults without epilepsy, those with incident epilepsy present with a higher prevalence of several chronic conditions, and compared to NHWs, Hispanics are significantly more likely to present with chronic conditions. Our findings highlight the importance of emphasizing health promotion and prevention, providing multidisciplinary care, and elucidating shared pathophysiology to identify opportunities for prevention.
Funding: Centers for Disease Control and Prevention (U48DP006404-03-01)