Social Vulnerability Index is Associated with Poor Epilepsy Care Delivery and Seizure Outcomes
Abstract number :
2.348
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2025
Submission ID :
180
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Rebeka Bustamante Rocha, MD – Massachusetts General Hospital; Harvard Medical School
Aanchalika Chauhan, BS – Massachusetts General Hospital
Maria A. Donahue, MD – Massachusetts General Hospital
Jhansi Anjana Rayapureddy, MS – Massachusetts General Hospital
Julianne Brooks, MPH – Massachusetts General Hospital; Harvard Medical School
Aya Elhassan, BS – Massachusetts General Hospital
Kathleen M. Farrell, MB BCh BAO – Epilepsy Foundation
Jeffrey Buchhalter, MD, PhD – Epilepsy Foundation
Lidia M.V.R. Moura, MD, MPH, PhD – Massachusetts General Hospital; Harvard Medical School
Peter Hadar, MD, MS – Massachusetts General Hospital; Harvard Medical School
Brandy Fureman, PhD – Epilepsy Foundation of America
Rationale: Vulnerable populations of people living with epilepsy (PWE) experience disparities such as increased emergency department (ED) visits, limited access to specialized care, and inconsistent antiseizure medication (ASM) use.1 Social determinants of health (SDOH) are crucial to understanding and addressing these inequities through effective and targeted interventions. We aimed to examine how SDOH and intersectionality influence the completion proportion of outcome measures at seven tertiary epilepsy centers.
Methods: In this retrospective, descriptive study, we analyzed data from 28,298 PWE with 77,912 patient visits enrolled in the Epilepsy Learning Healthcare System (ELHS) registry from 2020-2024. Using an intersectional analytic framework, we stratified data by race, ethnicity, and socioeconomic status (as proxied by area deprivation index) as key variables. Social vulnerability index (SVI) overall rankings were assigned to individuals based on a crosswalk of zip codes to counties and grouped into quartiles (Q1–Q4), with Q1 indicating the least vulnerable and Q4 the most vulnerable populations. We used a z-test for two proportions to test for differences between patients in Q1 and Q4 for CRF completion, presence of barriers to medication adherence (BMA), seizure frequency, and ED visits.
Results: The mean age was 19.5 years, with 49% males and 48% females. Most patients were White (54%) and non-Hispanic (78%). SVI was available for 18,201 patients. A total of 60,958 visits were recorded, with visits distributed similarly across all quartiles (18-20% each). Fewer vulnerable patients (Q4) reported daily or more (Q1 6% N=975, Q4 5% N=924), weekly (Q1 5% N=752, Q4 2% N=447), monthly (Q1 5% N=860, Q4 3% N=499), yearly (Q1 12% N=1,913, Q4 6% N=1,028), and less than yearly (Q1 5% N=792, Q4 4% N=716) seizure frequencies than those in Q1. Notably, more vulnerable patients (Q4) had lower rates of both patient-reported (Q4 0% N=73, Q1 11% N=1,715) and provider-reported seizure documentation (Q4 21% N=3,405, Q1 53% N=7,862), potentially biasing results. Patients in Q4 (N = 1,743) also reported no BMAs more often than those in Q1 (N = 1,011) (Q4: 10%, Q1: 6%). More vulnerable patients were more likely to report ED visits in the past year (Q4 6% N=1,100, Q1 1% N=221). All reported outcome differences had a p-value < 0.01.
Anti-seizure Medications