Abstracts

Rationale: Persons experiencing food insecurity are at increased risk for: having no usual source of care, postponing needed medical care and postponing medications in the past year, after controlling for demographics. Previous investigations have found that people with epilepsy are at increased risk for socioeconomic deprivation. Previous studies have found that persons experiencing hunger generate more cost per diagnosis related group (DRG). Patients who report prioritizing food over medications report increased Emergency Department visits. Since there are no previous studies looking at poverty and its effect on epilepsy in the U.S. it would be valuable to establish such population estimates. Methods: The CHIS is geographically stratified, random-digit dialed, two-stage telephone survey (n = 43,020) conducted on a biennial state-basis of non-institutionalized persons in California, over the age of 18 that tracks the prevalence of chronic disease burden and monitor health risks. The state of California assessed food security in 2005 using a validated six question scale used in federal surveys. Results: Of persons reporting a history of epilepsy, 41% (246/604) of respondents had an annual income < 200% federal poverty level (FPL). Persons with a history of epilepsy at < 200% FPL reported significantly lower rates of health insurance and prescription medication coverage than the non-epilepsy population > 200% FPL. Persons with a history of epilepsy report receiving food stamps at significantly higher rates compared to the non-epilepsy population. They also report that it was often true/sometimes true that food didn’t last and they couldn’t afford to buy more. They are also not being able to afford to eat balanced meals significantly more often in past year than the non-epilepsy population at < 200% FPL. Persons with a history of epilepsy also report cutting/skipping meals and eating less than they should more often than non epilepsy patients in the past 12 months. After controlling for demographics (gender, age, race/ethnicity, annual household income, educational attainment and urban or rural residence) persons with a history of epilepsy < 200% FPL are significantly less likely (OR 0.6) to report taking medication for their epilepsy. After controlling both demographics and comorbidities (asthma, obesity, Type II diabetes, high blood pressure, heart attack, stroke, high cholesterol and cancer) persons with a history of epilepsy < 200% FPL are half as likely (OR 0.5) to report taking medication for their epilepsy. Conclusions: Persons with a history of epilepsy, who are in poverty, face more obstacles to meet their basic daily needs for food. They are likely faced with making choices between medications and food. Better cooperation between social services and patient advocacy organizations may help close these gaps. Health professionals should step up their efforts to connect their patients in poverty to medication assistance programs.