Abstracts

Rationale: How individuals fare in sickness and in health depends to a large extent on their social position. Socially-based inequalities in epilepsy have been documented, but it is not clear how they affect the well-being of patients at entry into a cannabidiol (CBD) treatment program. Our aim was to examine associations between the social determinants of health?"age, gender, and socioeconomic factors?"and health status, quality of life, and mood states in this patient population. Methods: Baseline social and outcomes data were collected from patients with refractory epilepsy at entry into the University of Alabama at Birmingham CBD Program during 4/1/15-3/30/16 using standardized questionnaires. Socioeconomic constraints were assessed with family income < $40,000/year and financial strains in terms of money situation (ranging from "Comfortable with extra" to "Cannot make ends meet") and problems with food availability and paying for epilepsy medications ("sometimes or often" vs. "never"). Health status was rated by patient/caregiver on a scale from 0 ("poor") to 4 ("excellent"). Quality of Life in Epilepsy Inventory-89 (QOLIE-89) and Profile of Mood States (POMS) were administered to adults; the overall QOLIE-89 (1 missing) and POMS Total Mood Disturbance (TMD) scores were used. The analysis included Pearson correlations and ordinary-least-squares regression (alpha=.1). Results: The full sample (n=80; 38 adult, 42 children) was 51% male and 96% non-Hispanic white; mean age was 19 years (12.9); 23% had income < $40,000 and some experienced financial strains?"18% money, 13% food, and 8% medication-related. The health status, QOLIE-89, and POMS means were 2.3 (1.2), 50.0 (16.9), and 49.4 (9.7), respectively. Bivariate associations (Table 1) showed health ratings decreasing with age (p=.008) and income < $40,000 (p=.039); QOLIE-89 decreasing with money strain (p=.097); and, income < $40,000 being associated with money (p < .001), food (p=.026), and medication-related (p=.001) strains. The final model predicting health status showed main effects of age (p=.003) and income < $40,000 (p=.014) and their interaction (p=.055). For example, a higher-income 10-year-old had a predicted health rating of 3 ("very good"), followed by a higher-income 40-year-old with a rating of 2 ("good"), a low-income 10-year-old with a rating of 1 ("fair"), and a low-income 40-year-old with a rating of 0 ("poor"; Figure 1). Conclusions: Higher age and low income are associated with lower health ratings among epilepsy patients at entry into a CBD treatment. Older patients tend to be poorer and have lower perceived health than younger patients, suggesting potentially detrimental effects of epilepsy on patient/family socioeconomic circumstances and patient's perceived health over time. This finding is consistent with prior literature showing financial and treatment access struggles among adult patients with epilepsy. Further research utilizing larger and more diverse samples of patients and additional social and outcomes indicators is needed. Funding: State of Alabama