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Racial and ethnic minorities and older adults experience more complications related to status epilepticus and greater risk for such complications.
“Although studies have examined the epidemiology of [status epilepticus], the association between healthcare disparities and [status epilepticus] is under-investigated,” Gabriela B. Tantillo, MD, MPH, and colleagues wrote in a study published in Epilepsia. “Prior studies have shown that minority groups are less likely to receive outpatient neurology specialist care or to have epilepsy surgery, with some studies showing higher rates of [status epilepticus] overall in minority populations. Furthermore, the role of healthcare disparities in specific [status epilepticus]-associated outcomes, including EEG monitoring, intubation, tracheostomy, gastrostomy, and mortality, remains poorly understood.”
Dr. Tantillo and colleagues examined the impact of sociodemographic factors on mortality and the use of procedures frequently associated with morbidity in US patients with status epilepticus. The researchers identified hospitalizations for status epilepticus in the 2010–2019 National Inpatient Sample based on ICD-9 and ICD-10 codes and stratified the prevalence of status epilepticus according to demographics. They used logistic regression to examine factors associated with EEG monitoring, intubation, tracheostomy, gastrostomy, and mortality.
Race, Age and Income Influence Rate of Complications
The analysis included 486,861 hospitalizations for status epilepticus between 2010 and 2019, most of which (71.3%) were at urban teaching hospitals. More than half of the study population was non-Hispanic White (54.9%)
Prevalence rates for status epilepticus per 10,000 admissions were 27.3 for non-Hispanic Black patients, 16.1 for patients classified as non-Hispanic Other, 15.8 for Hispanic patients, and 13.7 for non-Hispanic Whites (P<0.01). The prevalence of status epilepticus was also higher in the lowest compared with the highest income quartile (18.7 vs 14.0; P<0.01).
Dr. Tantillo and colleagues found that race, income, and age impacted EEG monitoring; rates of intubation, tracheostomy, and gastrostomy; and mortality.
Researchers noted an association between older age with intubation, tracheostomy, gastrostomy, and in-hospital mortality. Specifically, patients aged 80 and older had the greatest odds of intubation (OR=1.50; 95% CI, 1.43-1.58), tracheostomy (OR=2.0; 95% CI, 1.75-2.27), gastrostomy (OR=3.37; 95% CI, 2.97-3.83), and in-hospital mortality (OR=6.51; 95% CI, 5.95-7.13).
Minority groups, including non-Hispanic Black patients, Hispanic patients, and those who identified as non-Hispanic Other, had higher odds of tracheostomy and gastrostomy compared with non-Hispanic White patients. Non-Hispanic Black patients had the greatest odds of tracheostomy (OR=1.70; 95% CI, 1.57-1.86) and gastrostomy (OR=1.78; 95% CI, 1.65-1.92).
The odds of EEG monitoring increased progressively with income quartile (OR for the highest income quartile=1.47; 95% CI, 1.34-1.62) and was higher for patients treated in urban teaching hospitals versus rural hospitals (OR=12.72; 95% CI, 8.92-18.14).
Compared with non-Hispanic White patients, mortality odds were lower in non-Hispanic Black patients (OR, 0.71; 95% CI, 0.67-0.75), Hispanic patients (OR=0.82; 95% CI, 0.76-0.89), and patients in the highest income quartiles (OR=0.90; 95% CI, 0.84-0.97).
Developing Solutions to Address Disparities
The results indicate that three groups—racial and ethnic minorities, older adults, and individuals of lower socioeconomic status—experience both a higher rate of complications related to status epilepticus and an increased risk for such complications, according to Dr. Tantillo and colleagues. In addition, patients who live in rural areas may have even less access to diagnostic tools, including EEG monitoring.
According to the researchers, clinicians who serve these patients represent “an appropriate target for quality improvement and education initiatives” to improve health outcomes.
Further, the racial, ethnic, and rural disparities identified by Dr. Tantillo and colleagues indicate the need for investment in these communities to improve health outcomes and reduce health inequalities.
“This might include augmenting the resources, personnel, and health education that these communities receive,” the researchers wrote. “More research is needed to determine the most effective ways of accomplishing this goal.”
Key Takeaways
- Prevalence rates for status epilepticus per 10,000 admissions were highest among non-Hispanic Black patients.
- Compared with non-Hispanic White patients, mortality odds were lower in non-Hispanic Black patients, Hispanic patients, and patients in the highest income quartiles.
- The odds of EEG monitoring increased with the income quartile and were higher for patients treated in urban teaching hospitals than in rural hospitals.
