Rural participants in an epilepsy self-management clinical trial report lower quality of life and self-efficacy
Abstract number :
2.023
Submission category :
11. Behavior/Neuropsychology/Language / 11A. Adult
Year :
2025
Submission ID :
237
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Author: Lisa Tan, MD – University Hospitals Cleveland
Rachel Branning, MD – University Hospitals Cleveland
Haitong Yu, BS – Case Western Reserve University
Nicole Fiorelli, BS – Case Western Reserve University
Jessica Black, BS – Case Western Reserve University
Maegan Tyrrell, BS – Carver College of Medicine
Farren Briggs, PhD – University of Miami
Gena Ghearing, MD – Mount Sinai
Presenting Author: MARTHA SAJATOVIC, MD – Case Western Reserve University
Rationale: Geography is a prominent social determinant of health (SDOH). Approximately 19% of the U.S population live in rural locales, which are disproportionally afflicted by health disparities. Epilepsy is a chronic disease requiring ongoing management, thus persons with epilepsy living in rural areas may have difficulties receiving appropriate care. Little is known about differences in PWE due to geography. We aimed to assess clinical and demographic factors participants in an epilepsy self-management clinical trial (NCT04705441) by geography of residence, with considerations for other SDOH.
Methods: Outcomes of interest included: quality of life (QOLIE31) functional status (SF-36) self-management (ESMS) self-efficacy (ESES), depression (PHQ-9), and social support (MSPSS). The independent variable of interest was geography of residence (categorized using Rural- Urban Continuum Codes: metro areas (RUCC 1-3), adjacent to metro areas (RUCC 4,6,8), and rural (RUCC 5,7,9)). Amongst covariates were other SDOH: income and education. Multivariable linear regression models were conducted, including the three SDOH and other covariates.
Results: Adjusting for likely confounders, geography was independently associated with several outcomes: rural PWE had lower ESES (p=0.045), lower QOLIE-31 total scores (p=0.025), and lower QOLIE-31-cognition subscore (p=0.043) compared to urban PWE. On average, rural PWE had an 11-point lower QOLIE-31 total score.
Conclusions: Rural PWE have worse outcomes in self-efficacy, quality of life, and cognitive functioning compared to urban PWE in the SMART clinical trial. These differences were significant after adjusting for potential confounders such as income and can therefore be driven by geography and related barriers to healthcare access.
Funding: Cooperative Agreement Number 6 U48DP006389 from the Centers for Disease Control and Prevention (CDC).
Behavior