Adults with Epilepsy Face Differing Contributors to Healthcare Utilization

Both demographic and socioeconomic factors are associated with how often adult epilepsy patients utilize emergency departments, according to findings presented at the American Epilepsy Society (AES) Annual Meeting in New Orleans.

Investigators from UCB Pharma conducted a long-term retrospective analysis of more than 95,000 epilepsy patients in order to collect more data about how this population uses emergency departments and their healthcare outcomes.

The patients lived in California, Florida, and New York, between 2003 - 2014. They had at least 1 inpatient epilepsy diagnosis in the two-year identification period and the researchers followed up for 4 years to track their inpatient and emergency department utilization data. Then, they categorized patients into groups based on age: those less than 15 years of age and those greater than 65 years of age.

The investigators monitored impact of socioeconomic factors, such as residence zip code, insurance type, and income, and demographic factors, like gender and race, to form their analysis.

The younger cohort had two-and-a-half times the emergency department usage as the older cohort across the first year of follow up, the researchers found. The younger cohort included about 10,000 patients—a much smaller group than the adult patients. This group also had 15% lower inpatient utilization for all care compared to the older patients.

In terms of care related specifically to epilepsy, the researchers found, the younger patients had 7.5 times higher emergency department utilization and nearly 4 times as many inpatient utilizations, compared to the older patient group.

The researchers analyzed the socioeconomic factors with respect to the top income quartile of each zip code and learned that the epilepsy patients in the bottom income quartile had 3 times more initial emergency room utilization and 7% higher inpatient utilization.

Patients in the bottom quartile had 2.65 times more emergency department utilization than the top quartile as well as 19% lower inpatient utilization, the investigators determined.

The gap between under-15 and over-65 was largely consistent beyond the first year of follow up, the researchers demonstrated. The younger group had emergency room utilization across the additional 3 years 2.09 times higher, and 7.39 times higher for direct epilepsy care compared to the older cohort.

The researchers also found that the patients in the bottom income quartile zip codes had long-term emergency department utilization that was 26% higher overall and epilepsy-specific visits to the emergency department that were 24% higher when compared to the top income quartile zip codes. This was true even after the researchers took other factors into account, they said.

“For people with epilepsy, demographic and socioeconomic factors are associated with overall inpatient and ED utilization, as well as epilepsy-specific utilization,” the study authors concluded. “Patients [aged less than] 15 years old and those of lower socioeconomic status have higher baseline utilization, particularly for emergency department utilization.”

These differences across age and socioeconomic groups remain intact over time, investigators confirmed, particularly from the scope of utilization 3 years out.

The study, “Longitudinal predictors of healthcare use in adults with epilepsy,” was published online on the AES website.