Rationale:
Racial inequalities are a highly prevalent and well documented problem in modern healthcare.1 In people with epilepsy specifically, it has been shown that Black patients have poorer access to epileptologists, poorer access to surgical treatment, lower rates of anti-seizure medication adherence, and increased mortality from epilepsy2. We sought to explore what racial disparities exist for people with epilepsy seeking care within the University of Rochester Medical Center.
Methods:
Using the Slicer Dicer data analytics tool in Epic, we examined differences in care between racial groups in people with epilepsy over the past 10 years. Specifically, we evaluated the University of Rochester neurology resident clinic, general neurology attending clinic, and epilepsy subspecialty clinic, focusing on the population breakdown within those clinics, risk of ED visit or hospital admission and risk of no-show to appointments. We also examined data regarding emergency room visits and hospital admissions.
Results:
We found that the percentage of patients with epilepsy identifying as Black/African American in the resident clinic was nearly twice that of patients in the attending clinics (17.5% vs 9.4% [general neuro] and 10.7% [epilepsy]). In all of the evaluated clinics, Black/African American patients were at higher risk for ED visits or hospital admission, and had a higher risk of no-showing to clinic visits than their white counterparts. Among all-comers to the ED, white patients were more likely than Black/African American patients to be admitted to the hospital after an ED visit, both for the chief complaint of seizure and other chief complaints. Lastly, Black/African American patients made up a larger percentage of ED visits for seizure than ED visits in general.
Conclusions:
The well-described national neurodisparities in people with epilepsy are present at the University of Rochester as well. The disparity that seems the most amenable to correction at the departmental level is the disparity in populations between the resident and attending clinics. Our Black/African American patients are also higher risk for coming to the hospital for their seizures, and more likely to no show to their appointments. Developing an algorithim to trigger referral to subspecialty epilepsy care based only on medical factors could help reduce the disparity in access to care. Socioeconomic factors should be considered more intentionally and more thoroughly discussed with patients. Cost and availability should be discussed when deciding anti-seizure medications to use. Transportation and other barriers to attendance should be discussed when deciding on follow up with our patients as well. Gaining a better understanding of these inequities could help to inform departmental policy moving forward.
References:
1https://www.cdc.gov/minorityhealth/racism-disparities/index.html
2 Robbins NM, Charleston L 4th, Saadi A, et al. Black Patients Matter in Neurology: Race, Racism, and Race-Based Neurodisparities. Neurology. 2022 Jul;99(3):106-114. DOI: 10.1212/wnl.0000000000200830. PMID: 35851551; PMCID: PMC9302935
Funding: None