Authors :
First Author: Ima Ebong, MD, MS – University of Kentucky College of Medicine, Lexington, KY, USA
Pam Eads, MBA – UCB Pharma, Smyrna, GA, USA; Georgette Charles, PhD – UCB Pharma, Smyrna, GA, USA
Rationale:
The epilepsy experience differs between individuals and is influenced by many factors, including inequities based on socially-defined race and ethnicity. A history of racism places certain groups at a disadvantage. We sought to better understand factors
contributing to health disparities in black patients living with epilepsy (PLWE) and the value of programs for healthcare professional (HCP) to reduce disparities.
Methods:
Online cross-sectional survey was administered to neurologists (November 8 to 18, 2022). Screening questions assessed eligibility; criteria included ≥20% of black patients among all PLWE, and management of ≥10 PLWE in the last 30 days in academic or community settings. Survey questions assessed understanding and recognition of health disparities in PLWE and the value of programs for HCPs. Statistical comparisons were performed by setting (academic vs community) and by subspecialty (epilepsy vs other vs none).
Results:
Of 101 neurologists, 48.5% and 51.5% worked in academic and community settings, respectively. Subspecialties were epilepsy (49.5%), other (29.7%) and none (20.8%). Neurologists reported that 28.3% of their patients were black, but few neurologists identified as Black (2.0%) vs White (39.6%) or Asian (24.8%). Situations most frequently cited as having a negative impact on health were ‘inconsistent compliance’ and 'comorbidities’ in all PLWE, and ‘missed appointments’ and 'mistrust in the healthcare system’ in Black PLWE (Figure 1). Except for "mistrust in the healthcare system" and "inconsistent treatment compliance," which were cited as disproportionally affecting Black vs all PLWE, respectively, between-group differences in cited health disparities were small. Academic vs community neurologists were more likely to report "comorbidities" and "lack of transport" as disparities in all PLWE, and "lack of transport"also in Black PLWE specifically (Figure 2). More academic than community neurologists agreed that racism is a social determinant of health (69.4% vs 44.2%). Differences (95% confidence level) among neurology subspecialties were noted for top health disparities for Black PLWE: epilepsy specialists (n=50) and those with other specialty (n=30) reported "lack of transport" more than neurologists with no specialty (n=21) (78.0% and 66.7% vs 33.3%), and epilepsy specialists reported "treatment refusal" more than other specialists (74.0% vs 46.7%). Overall, many respondents (45.5–61.4%, depending on the program) considered programs for HCPs helpful to improve treatment outcomes in Black PLWE. More academic than community neurologists were willing to participate in these programs (49.0–69.4% vs 30.8–51.9%).
Conclusions:
Neurologists perceived little differences in health disparities between all PLWE and Black PLWE. More academic than community neurologists agreed racism is a social determinant of health and were willing to participate in programs for HCPs to improve treatment outcomes in Black PLWE. Increasing HCP awareness through these programs may help address health disparities in this patient population.
Funding:
UCB Pharma