Abstracts

Rationale: People with epilepsy (PWE) experience a wide range of chronic and physical comorbidities that influence their care and outcomes. Understanding the presence and role of comorbidities for people with epilepsy remains a critically important area of epilepsy research. In addition to understanding the overall prevalence of combinations of conditions, it is critical to understand racial and ethnic disparities that accompany these. Most literature surrounding disparities in chronic conditions has focused on only one condition at a time, and disparities have not been examined within the context of epilepsy. In this study, we examine the burden and racial/ethnic disparities of chronic and acute conditions, injuries, and symptoms in a large and diverse group of PWE on Medicaid.

Methods: Using 5 years (2010 – 2014) of Medicaid claims data we identified adult PWE and used all available claims and diagnoses to identify each person’s Clinical Classification Codes, which collapses diagnosis codes “into a smaller number of clinically meaningfully categories.” We used association rule mining (ARM), a rule-based machine learning technique which can elucidate previously unknown constellations of conditions that most frequently co-occur. Using ARM, we identify the top combinations of conditions and stratify these by race/ethnicity to identify potential prevalence disparities. Additionally, we examine the top combinations of conditions in individuals in the top quartile of hospitalizations and emergency department visits.

Results: Among 81,963 PWE the most common conditions were: anxiety and mood disorders (46.5%), hypertension (36.9%), back problems (35.2%), developmental disorders (31.6%), and headache (29.5%). When examining combinations of conditions, anxiety and mood disorders continued to have an outsized prevalence – appearing in nearly every combination. There were notable disparities in this disease burden, with American Indians and Alaskan Natives having a substantially higher prevalence of developmental disabilities, while Black individuals had a higher prevalence of hypertension. These disparities persisted to the higher-order combinations including these conditions. High utilizers had a much higher disease burden, with 75.8% having an anxiety or mood disorder, as well as a higher burden of injuries, but a lower prevalence of developmental disorders. Overall, we observe a higher prevalence of these conditions among PWE on Medicaid, and a larger disparity in the prevalence across race/ethnicities than reported in the general population.

Conclusions: This study shows the high prevalence of psychiatric and physical conditions which likely affect quality of life for PWE, and importantly racial and ethnic disparities. Interventions to improve clinical care and reduce disparities for PWE should focus not only on epilepsy, but on integrated care for these varied, but highly prevalent, acute and chronic conditions.

Funding: Please list any funding that was received in support of this abstract.: Research reported in this publication was supported by the Centers for Disease Control and Prevention (CDC) under award number Special Interest Project 3 U48 DP005030-05S1 and the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health (NIH) under award number F31MD015681. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention or the National Institutes of Health.