Abstracts

Rationale: There are well-documented associations between low-income, low-education levels, and epilepsy. However, the impact of a person’s SES on the effects of epilepsy have been less studied. The present study aimed to investigate the associations between SES and epilepsy, the severity of epilepsy, access to care, and socioeconomic outcomes of epilepsy. Methods: This study is a national cross-sectional study based on the Swedish National Patient Register (NPR). Epilepsy was defined as a single ICD-10 code of G40 in the NPR, meeting the recommendation from the ILAE epidemiology commission report 2010 for probable epilepsy. Three controls were randomly selected from the Swedish population register for each case, matched for age, gender, and place of birth.Information on socioeconomic characteristics was collected from the Longitudinal integration database for health insurance and labour market studies (Statistics Sweden, LISA). The Swedish Prescribed Drug Register holds information on all prescribed pharmaceuticals dispensed in Sweden and was used to collect information on antiepileptic drugs (AEDs). The Swedish Cause of Death register was used to collect information about deaths. The study cohort consisted of all adult persons with epilepsy (PWE) with a registered epilepsy diagnosis in the NPR in 2000-2015 (n = 126,406) and controls (n =379,131). All data were anonymized and cross-referenced by the National Board of Health and Welfare before the authors were given access to them. All analyses were computed in SPSS version 23 and the statistical tests applied were Chi square, Mantel Haenszel, logistic regression, and interaction effect. Results: Education and income levels were lower for cases than for controls, while somatic and psychiatric comorbidities were more common. Both hospitalizations for epilepsy and treatment with more than one AED were more common in persons with lower income or education. By contrast, persons with high SES were more likely to be treated by a neurologist. Only 78% of persons in the group with the lowest education had a prescription from a neurologist, compared to 91% in the highest education group (p<0.001). To investigate if a higher level of education was protective against poor socioeconomic outcomes of epilepsy, we assessed the impact of epilepsy on income and employment in persons with different levels of educational attainment. The difference between cases and controls regarding low income or unemployment was more distinct among persons with shorter education. Low income and unemployment were studied separately, and there was a significant interaction (p<0.001) effect between epilepsy and educational level, i.e., the effect of epilepsy on unemployment or low income seems not to be constant but also depends on the educational level. Conclusions: To our knowledge, this is the first time that a nationwide study demonstrates an association between the impact of epilepsy and SES. The results in the present study indicate that countries with insurance-based systems will not succeed to close the socioeconomic treatment gap by solely expanding their health care coverage. Conversely, countries with publicly funded health care need to implement other measures to prevent unequal access to care. In order to proceed in this work, more research needs to be devoted specifically to the impact of epilepsy in persons with low SES. Funding: Swedish Society of Medicine, Göteborgs läkaresällskap, Swedish Society for Medical Research, Magnus Bergvall foundation, Jeanssons foundation, Felix Neubergh foundation, NEURO Sweden.