Racial & Ethnic Disparity in Infantile Spasms
Abstract number :
3.22
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2021
Submission ID :
1825959
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Kelli Morrissey, MPAS, PA-C - Children's National Hospital; Kathryn Havens, PA-C - Neurology - Children's National Hospital; Carrin Brandt, LMFT - Neurology - Children's National Hospital; Emily Matuska, BS - Neurology - Children's National Hospital; Lauren Vilchinsky - Children's National Hospital; Anne Vasiliadis, CPNP-AC - Neurology - Children's National Hospital; Elizabeth Wells, MD - Neurology - Children's National Hospital; Tayyba Anwar, MD - Neurology - Children's National Hospital; Tammy Tsuchida, MD, PhD - Neurology - Children's National Hospital; John Schreiber, MD - Neurology - Children's National Hospital; Thuy-Anh Vu, MD - Neurology - Children's National Hospital; Claudine Sinsioco, MD - Neurology - Children's National Hospital; Dewi Depositario-Cabacar, MD - Neurology - Children's National Hospital; Tesfaye Zelleke, MD - Neurology - Children's National Hospital; Taeun Chang, MD - Neurology - Children's National Hospital; William Gaillard, MD - Neurology - Children's National Hospital; Archana Pasupuleti, MD - Neurology - Children's National Hospital
Rationale: Studies on racial and ethnic health disparities in the U.S. show that minority groups experience higher rates of illness and death across a range of health conditions including epilepsy (1). Little to no data exists on racial or ethnic disparities for infantile spasms (IS).
Methods: A prospective cohort of IS referrals to the Infant Epilepsy Program (IEP) at Children’s National Hospital (CNH) in the District of Columbia (DC) between April 2019 and March 2021 were examined for age, gender, race & ethnicity (per NIH categories), incidence, etiology, time to treatment initiation, and treatment response. Etiology was categorized as genetic (pathologic findings only) or structural (congenital malformation/dysgenesis or acquired insults). The 2019 U.S. Census Bureau racial & ethnic demography of the greater DC metropolitan region was used for comparison: 45% White, 25% Black or African American, 16% Hispanic, 10% Asian (2). We hypothesized that there would be no racial or ethnic difference in incidence, time to treatment initiation, and treatment response. Patients who received initial IS treatment outside of CNH or had incomplete treatment course were excluded from this study. Chi-square tests with a p-value ≤ 0.05 were considered significant.
Results: 49 consecutive IS infants were treated in the IEP clinic over 24 months: 19 (38.8%) Black, 14 (28.6%) Hispanic, 13 (26.5%) White, and 3 (6.1%) Asian. This profile was significantly different from expected of the population in the DC region (χ2= 32.03, p< 0.00001) or DC proper (χ2= 32.29, p< 0.00001). A disproportionate number were from Black or Hispanic populations (33 or 67.3%, χ2= 11.09, p< 0.001). Etiology of IS is presented in Table 1. Brain MRI structural findings were more common in Blacks than Whites (χ2=5.4, p=0.02), Asians or Hispanics (χ2=4.53, p=0.03), in particular congenital structural findings (Hispanics χ2=3.86, p=0.05; Whites χ2=7.16, p=0.007). The combination of both structural & genetic etiologies was more common in Blacks than Hispanics (χ2=10.59, p=0.001). Median time to treatment initiation was 3 days (range 0-21 days) and did not differ between groups. Overall resolution with initial treatment was achieved in 15 (30.6%) infants (1 or 5.3% of Blacks, 7 or 50% of Hispanics, 5 or 38.5% of Whites, 2 or 66.7% of Asians) (Table 2). Blacks were usually initiated on prednisone and less likely to respond to initial IS treatment (Hispanics χ2=8.78, p=0.003; White χ2=5.58, p=0.02; Asians χ2=8.29, p=0.004).
Conclusions: This is the first report of racial & ethnic disparity in IS. The incidence of IS in the Black or Hispanic population in the DC and greater DC area was higher than expected. Yet, response to initial treatment was less likely in Blacks. Further studies are needed for validation in other regions and to examine the cause(s) for this disparity, such as pandemic effects, insurance denials, patient counseling, or parent decline.
(1) https://www.cdc.gov/healthequity/racism-disparities/research-articles.html
(2) https://censusreporter.org/profiles/31000US47900-washington-arlington-alexandria-dc-va-md-wv-metro-area/
Funding: Please list any funding that was received in support of this abstract.: None.
Clinical Epilepsy