Significant Racial Disparities Persist in Status Epilepticus

NASHVILLE, Tennessee ― New research shows stark racial and ethnic discrepancies in healthcare outcomes for patients with status epilepticus (SE).

Investigators found that among Black patients with SE, the hospitalization rate was twice that of their White counterparts. Other findings reveal age and income disparities.

Dr Gabriela Tantillo Sepúlveda

“The results suggest that racial minorities, those with a lower income, and the elderly are an appropriate target to improve health outcomes and reduce health inequality,” Gabriela Tantillo Sepúlveda, MD, assistant professor of neurology, Baylor College of Medicine, Houston, Texas, told Medscape Medical News.

The findings were presented here at the American Epilepsy Society (AES) 76th Annual Meeting 2022.

An Examination of Outcomes

SE is associated with high rates of morbidity and mortality. Disparities in epilepsy care have previously been described, but little attention has been paid to the contribution of disparities to SE care and associated outcomes.

Researchers used 2010–2019 data from the Nationwide Inpatient Sample, a database covering a cross-section of hospitalizations in 48 states and the District of Columbia. From relevant diagnostic codes, they calculated SE prevalence as the rate per 10,000 hospitalizations and stratified this by demographics.

Over the study period, investigators identified 486,861 SE hospitalizations, most (71.3%) at urban teaching hospitals.

SE prevalence was highest for non-Hispanic (NH) Black patients, at 27.3, followed by NH-others, at 16.1, Hispanic patients, at 15.8, and NH-White patients, at 13.7 (P < .01).

The finding that Black patients had double the rate as White patients was “definitely surprising,” said Tantillo Sepúlveda.

Research over the past 20 years revealed similar disparities related to SE, “so it’s upsetting that these disparities have persisted. Unfortunately, we still have a lot of work to do to reduce health inequalities,” she said.

The investigators found that the prevalence of SE was higher in the lowest-income quartile compared to the highest (18.7 vs 14; P < .01).

Need for Physician Advocacy

Unlike previous studies, this research assessed various interventions in different age groups and showed that the likelihood of intubation, tracheostomy, gastrostomy, and in-hospital mortality increased with age.

For example, compared to the reference group (patients aged 18–39 years), the odds of intubation were 1.22 (95% CI, 1.16 – 1.27) for those aged 40–59 years and 1.48 (95% CI, 1.42 – 1.54) for those aged 60–79. Those aged 80 and older were most likely to be intubated, at an odds ratio (OR) of 1.5 (95% CI, 1.43 – 1.58).

Elderly patients were most likely to undergo tracheostomy (OR, 2.0; 95% CI, 1.75 – 2.27), gastrostomy (OR, 3.37; 95% CI, 2.97 – 3.83), and to experience in-hospital mortality (OR, 6.51; 95% CI, 5.95 – 7.13), compared to the youngest patients.

These intervention rates also varied by racial/ethnic groups. Minority populations, particularly Black people, had higher odds of tracheostomy and gastrostomy compared to NH-White persons.

The odds of undergoing electroencephalography (EEG) monitoring progressively rose as income level increased (OR, 1.47; 95% CI, 1.34 – 1.62) for the highest income quartile vs the lowest quartile. The odds of undergoing EEG monitoring were also higher at urban teaching hospitals than at rural hospitals.

Tackling these disparities in this patient population include increasing resources, personnel, and health education aimed at minorities, low-income patients, and the elderly, said Tantillo Sepúlveda. She added that more research is needed “to determine the most effective ways of accomplishing this goal.”

The medical community can help reduce disparities, said Tantillo Sepúlveda, by working to improve health literacy, to reduce stigma associated with seizures, and to increase awareness of seizure risk factors.

They can also work to expand access to outpatient neurology clinics, epilepsy monitoring units, and epilepsy surgery. “Ethnic and racial minorities are less likely to receive epilepsy surgery for temporal lobe epilepsy, which has been shown to improve quality of life and reduce seizure burden,” Tantillo Sepúlveda noted.

Across-the-Board Problem

Commenting for Medscape Medical News, Daniel Lowenstein, MD, professor of neurology, University of California, San Francisco, said the findings aren’t at all surprising.

“It’s yet another piece of evidence on what has now become a rather voluminous literature that documents the very significant disparities that exist in our healthcare system,” said Lowenstein “There’s just a huge literature on ‘name your disease and you’ll see the disparities.’ “

Disparities exist, for example, in diagnosing breast cancer and prostate cancer, in the treatment of stroke and in related outcomes, and there is a well-documented “big disparity” in the approach to pain control among patients presenting at the emergency department, said Lowenstein.

However, he doesn’t know how disparities in epilepsy and specifically in SE compared to disparities regarding other diseases and disorders. He noted that in the case of epilepsy, the situation is likely exacerbated by the stigma associated with that disease.

Lowenstein agreed that clinicians should play a role in reversing disparities. “We as physicians have a responsibility to be a voice for change in our healthcare system.”

The study was supported by the Center of Excellence for health equity, training, and research at the Baylor College of Medicine. Tantillo Sepúlveda and Lowenstein report no relevant financial relationships.

American Epilepsy Society (AES) 76th Annual Meeting 2022: Abstract 1.408. Presented December 3, 2022.

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