Abstracts

Rationale: The importance of epidemiology in people of low socioeconomic status has been stressed as a critical area of limited knowledge in persons with epilepsy. The goal of this study was to examine the prevalence of self-reported serious psychological distress based on the validated Kessler 6 (K6) scale, in persons with a history of epilepsy (PWHE) in poverty. To date, no previous studies have analyzed the association between poverty and epilepsy in the United States. Methods: The CHIS is geographically stratified, random-digit dialed, two-stage telephone survey (n = 43,020) conducted on a biennial state-basis of non-institutionalized persons in California, over the age of 18 that tracks the prevalence of chronic disease burden and monitors health risks. Four groups are presented; (1) those with a history of epilepsy < 200% of the Federal Poverty Level (FPL), (2) those with a history of epilepsy > 200% FPL, (3) those not reporting a history of epilepsy < 200% FPL and (4) those not reporting a history of epilepsy > 200% FPL. Results: Of persons reporting a history of epilepsy, 41% (246/604) of respondents had an annual income < 200% FPL, yielding an adjusted lifetime prevalence rate of 0.5% [98.33% CI 0.4-0.7]. California adults with a history of epilepsy < 200% FPL reported feeling depressed, feeling worthless and that everything is an effort in the past 30 days significantly more than the other 3 groups. They reported feeling nervous and restless more than groups 3 and 4. Feelings of hopelessness were significantly higher in group 1 compared to groups 2 and 4. California adults with a history of epilepsy < 200% FPL reported significantly higher amounts of serious psychological distress based on the K6 composite score than groups 3 and 4. After adjusting for demographics (gender, age, race/ethnicity, income, education and residence) and other comorbid conditions (asthma, obesity, diabetes, hypertension, heart attack, stroke, high cholesterol and cancer), logistic regression analyses reveal PWHE < 200% FPL reported significantly greater odds for fair or poor self-rated health status and > 15 physically unhealthy days in the past 30 days than the other three groups. They also have significantly greater odds of reporting > 15 days per month of mentally unhealthy days, general unhealthy days and normal activity limitation days than groups 3 and 4. Conclusions: The primary epilepsy population of concern for disparities in health is those at < 200% FPL. Persons with a history of epilepsy < 200% FPL have significantly higher rates of serious psychological distress and poor health related quality of life after controlling for demographics and comorbidities. Psychological well-being needs to be incorporated into any comprehensive treatment strategy for managing epilepsy and maximizing quality of life.