Abstracts

Rationale: Prior studies have suggested that people with epilepsy (PWE) with lower socioeconomic status (SES) have higher mortality rates of death compared to other low SES individuals (1) or high SES PWE (2). However, these studies were limited to a single state and time period. In this study, we aim to analyze the impact of community poverty levels on the rates of epilepsy mortality in three diverse geographic regions in the U.S. by comparing rates of PWE presenting to medical examiner offices for death investigation in low and high income geographic regions. We further examine if disparities in mortality rates have persisted over time. Methods: We queried all decedents who were presented for medico-legal investigation at three medical examiner’s offices across the country (New York City, Maryland, San Diego Co.) in 2009-2010 and 2014-2015. We identified all decedents where epilepsy or seizure was listed as a cause or contributor to death on the death certificate. We then reviewed the available records that included autopsy reports, field investigator notes and medical records. We used income level in the ZIP code of residence as a surrogate for SES. For each region, ZIP code regions were ranked by median household income and divided into quartiles based on total population for two different time periods separately (U.S. Census Bureau, 2010 and American Community Survey,2011-2015). Region, age and income level adjusted epilepsy prevalence in each ZIP code was estimated using data from 2010 CDC National Health Interview Survey. Confidence intervals for rates and rate ratio were calculated using OpenEpi (www.openepi.com). Results: Between 1/1/2009-12/31/2010, we identified 308 decedents (170 in NYC, 76 in Maryland, 62 in San Diego Co) with epilepsy as cause/contributor to death. The overall adjusted prevalence of active epilepsy was 8.8 per 1,000. The overall crude rate of death undergoing medico-legal examination was 0.97. The crude death rates were 0.6 (95% CI: 0.4-0.8) per 1000 person-year in highest income quartile and 1.3 (95% CI: 1.1-1.6) per 1000 person-year in lowest income quartile. ME office adjusted rate ratio between lowest and highest income quartile was 2.3 (95% CI: 1.6-3.3; p < 0.0001). Between 1/1/2014-12/31/2015, we identified 236 decedents (89 in NYC, 73 in Maryland, 85 in San Diego Co.) with epilepsy as cause/contributor to death. The overall crude rate of death undergoing medico-legal examination was 0.76. The crude death rates were 0.4 (95% CI: 0.2-0.6) per 1000 person-year in highest income quartile and 1.0 (95% CI: 0.8-1.2) per 1000 person-year in lowest income quartile. ME office adjusted rate ratio between lowest and highest income quartile was 2.4 (95% CI: 1.6-3.7; p < 0.0001). Conclusions: The rate of epilepsy-related deaths was significantly higher in people with lowest SES compared to highest SES in individuals undergoing medico-legal investigation and the difference persists over a 5 year time period. Further studies are needed to understand the causes of these disparities.References:1. Kaiboriboon K, Schiltz NK, Bakaki PM, Lhatoo SD, Koroukian SM. Premature mortality in poor health and low income adults with epilepsy. Epilepsia. 2014 Nov;55(11):1781-8.2. Wilson DA, Malek AM, Wagner JL, Wannamaker BB, Selassie AW. Mortality in people with epilepsy: A statewide retrospective cohort study.Epilepsy Res. 2016 May;122:7-14. Funding: FACES ( Finding a Cure For Epilepsy and Seizures )