Abstracts

Rationale: Research in other chronic conditions indicates that there are disparities in health care use in the United States by socioeconomic status. Little is known about the role of socioeconomic factors in health care use among people with epilepsy. The purpose of this study is to examine the variation in health care use among low-income Medicaid and uninsured people with epilepsy receiving treatment in publicly subsidized settings compared to middle- and upper-income individuals with insurance treated in a private health care setting. Methods: Approximatley 600 patients with epilepsy were recruited at three sites serving predominantly low-income populations in Houston, Texas and New York City and one site serving primarily middle- and upper-income patients in Houston, Texas. Patients were interviewed four times over a 12-month period. The interview questions covered demographics and coverage, seizures and health care use, drug side effects, co-morbidities, and health outcomes. Socioeconomic status was assessed in terms of income, education, and insurance coverage. We examined baseline differences in ER use, hospital admissions, physician visits, and medications with pooled data from participating patients. The role of socioeconomic factors in explaining variation in use was examined using regression models controlling for other important demographic and need characteristics of patients. Additional analyses explored the relative influence on health care use of specific socioeconomic factors.Results: We have analyzed data from approximately 200 cases ranging in age from 13 to 78 years, with a mean of 41 years. Most patients (59%) are female; 65% are White, 31% are African American, 24% are Hispanic, and 4% indicated other backgrounds. The mean number of persons living with the respondents is three; 14% live alone. Most had completed high school (75%), 51% attended college, and 8% attended graduate or professional school. The mean number of years with epilepsy was 16 and 70% had one or more seizures in the last 12 months. About 60% were on monotherapy and 40% on polytherapy. We expect to find considerable variation by site in all four measures of health care use. Hospital admissions and emergency room visits are expected to be higher among patients treated at the three public sites. Physician visits and use of antiepileptic drugs with low drug-drug interactions is expected to be higher for middle- and upper-income groups. Controlling for all other factors, Medicaid patients are expected to have the highest use of all services followed by privately insured and uninsured. Socioeconomic factors are expected to explain a small but significant percentage of the variation in use.Conclusions: There are disparities in health care use associated with the socioeconomic status of indviduals with epilepsy. With documentation of the nature and magnitude of these disparities we can move to the next step of determining the patient factors, health care practice issues, and environmental factors that cause the disparities.