Abstracts

This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session

Rationale: Approximately 470,000 U.S. children have epilepsy. Given that epilepsy is a chronic condition, its health-related outcomes are influenced by socioeconomic factors. The prevalence of epilepsy is higher in adults with low socioeconomic status (SES), yet adult patients with lower SES are less likely to adhere to their medication regimen. While healthcare disparities exist among adult epilepsy patients, the extent and effect of these disparities remain unclear among children. The objectives of this study were to examine whether pediatric patients with epilepsy (1) have lower SES than or (2) utilize healthcare resources differently from their peers.

Methods: Data from the 2016-2019 National Survey of Children’s Heath (NSCH) were used to identify U.S. children with active “epilepsy or seizure disorder.” Children with vs. without epilepsy were compared on demographic, socioeconomic, and healthcare utilization variables using second-order Rao-Scott adjusted χ2 tests or the adjusted Wald test as appropriate. Logistic regressions were utilized to model SES and healthcare utilization variables.

Results: This analysis included 131,326 children ages 0 to 17, of whom 835 were diagnosed with active epilepsy. The estimated prevalence of active epilepsy was 0.6% given a population of 73,084,673. A significantly higher proportion of patients with epilepsy were Black, non-Hispanic. There were no significant differences between groups in child sex, insurance coverage, or caregiver education status. Patients with epilepsy were significantly more likely to have visited an emergency department 1 time (aOR=2.9, 95% CI: 2.1-4.0) or >2 times (aOR=10.2, 95% CI: 7.3-14.2). Children from households with higher incomes relative to federal poverty level were less likely to have active epilepsy (Table 1). Finally, children with epilepsy were, over the prior 12 months, significantly more likely to: have seen a healthcare professional for medical care (aOR: 2.7; 95% CI: 1.4-5.1), had at least one preventative checkup (aOR: 2.3; 95% CI: 1.4-3.9), and receive medical care from a specialist (aOR: 10.3; 95% CI: 7.7-13.8). Still, 7.7% of children with epilepsy needed healthcare but did not receive it, representing 2.6 times the adjusted odds of that for children without epilepsy. Among those children who did not receive needed care, the most common and significant barriers were: ineligibility for services (aOR: 3.2; 95% CI: 1.0-10.2), problems getting an appointment (aOR: 3.9; 95% CI: 2.4-6.4), and transportation issues (aOR: 4.7; 95% CI: 2.0-11.0) (Table 2).

Conclusions: The weighted U.S. prevalence of pediatric epilepsy was 0.6%. Children with epilepsy were more likely than their peers to live in lower income households, visit an emergency room, and see healthcare professionals (specifically at preventative or specialist visits). However, children with active epilepsy had 2.6 times the odds of not receiving needed healthcare. The most common barriers were: service eligibility, appointment scheduling, and transport. These barriers should be addressed on state/federal levels to improve access to needed medical care for children with epilepsy specifically, and for those with other chronic medical conditions broadly.

Funding: None