Factors Associated with Frequent Emergency Visits for Seizure/Epilepsy: A Multi-state Analysis
Uma Sarwadnya1, Leila Alidoost1, Jennifer Dai1, Jennifer Geller1, Kylie Getz3, Brad Kamitaki2
1Rutgers-Robert Wood Johnson Medical School, 2Neurology, Rutgers-Robert Wood Johnson Medical School, 3Biostatistics, Rutgers University School of Public Health
Objective:
Identify factors associated with frequent emergency department (ED) visits for seizure/epilepsy.
Background:
In the US, more than one million people with epilepsy experience refractory seizures, limiting their quality of life and risking further complications. Prior studies have demonstrated clear racial and socioeconomic disparities when managing drug-resistant epilepsy, however, factors associated with frequent ED visits are largely unknown.
Design/Methods:
We conducted a multi-state (NY, FL, WI, MD) retrospective cohort study on adult patients presenting to the ED with a primary diagnosis of seizure/epilepsy using the all-payer Healthcare Cost and Utilization Project State Emergency Department and State Inpatient Databases (SEDD and SID). We tracked repeated ED visits for each patient longitudinally between 1/1/2016 and 12/31/2018. We performed a multivariable logistic regression analysis modeling factors we hypothesized were associated with frequent (>2) ED visits (primary payer, race/ethnicity, median income of zip code), adjusting for other variables.
Results:
We identified 200,962 patients who visited the ED for seizure/epilepsy, of whom 29,598 (14.7%) presented >2 times during the study period. Compared to private insurance, those with Medicare (odds ratio [OR] 1.90; 95% confidence interval [CI]: 1.82-1.99), Medicaid (OR 2.01; 95% CI: 1.93-2.09), or no insurance (OR 1.55; 95% CI: 1.48-1.62) were more likely to have >2 ED visits. Black patients were disproportionately represented versus white patients (OR 1.60; 95% CI: 1.55-1.65); there was no significant association seen with other racial/ethnic groups. Additionally, we observed more frequent ED utilization among patients living in low-income zip codes (0-25th percentile of median household income; OR 1.65; 95% CI: 1.58-1.73).
Conclusions:
Patients with public insurance or no insurance, identifying as Black, and living in low-income zip codes were more likely to present frequently to the ED for seizures, highlighting inequities in epilepsy care. Future studies should target effective, community-based interventions to reduce these disparities and increase access to comprehensive epilepsy centers.