Racial and Ethnic Disparities in the Clinical Outcomes of Patients with Encephalitis
Sienna Wu1, Rodrigo Hasbun1, Arun Venkatesan2, John Probasco2, Laya Rao1, Paris Bean1, Ralph Habis3, Ashley Heck1, Rajesh Gupta1
1UTHealth Houston, 2Johns Hopkins Hospital, 3Johns Hopkins School of Medicine
Objective:

To determine if there are significant differences in clinical outcomes between encephalitis patients of different racial and ethnic backgrounds.

Background:
Encephalitis is an inflammation of the brain caused by several infectious or non-infectious etiologies (e.g., autoimmune encephalitis). The influence of racial disparities in autoimmune disease outcomes, such as multiple sclerosis, is established in current literature.
Design/Methods:
A retrospective cohort study was conducted using electronic health records in Greater Houston and Baltimore areas between 2005 and 2022. Patients were dichotomized by race into non-Hispanic Whites and ethnic minorities. A bivariate analysis was used for dichotomous clinical features, while median was used for continuous variables.
Results:

Of the 601 patients, 313 were non-Hispanic White (52.1%) and 288 were of an ethnic minority (47.9%). Ethnic minority patients were significantly younger (median 44 vs 56; p = <.001), with a higher proportion of abnormal electroencephalograms (EEG) compared to non-Hispanic Whites (84% v 72.1%; p = .005). Ethnic minority patients had a higher incidence of autoimmune encephalitis (24% vs 16.7%; p = .042). Non-Hispanic Whites were more likely to present with memory deficits (36.7% vs 26.7%; p = .01). Ethnic minority patients had worse Sequential Organ Failure Assessments (SOFA) (44.2% with SOFA >3 vs 34.4%; p = .025) and Full Outline of UnResponsiveness Scores (FOUR Score) (28.6% with FOUR Score <14 vs 20.4%; p = .026) at presentation. A higher proportion of non-Hispanic Whites had worse outcomes on the Glasgow Outcome Scale (GOS) (76.5% with GOS <5 vs 50.2%; p = <.001), and significantly more ethnic minority patients were alive post-treatment (73.2% vs 44%; p = <.001).

Conclusions:

We found significant differences between non-Hispanic White and ethnic minority encephalitis patients in age, EEGs, presenting signs, and patient outcomes. Further work is needed to determine the role of age as a confounding variable in patient outcomes.

10.1212/WNL.0000000000205915