Sociodemographic disparities in epilepsy care: Results from the Houston/New York City health care use and outcomes study.
OBJECTIVE
The purpose of this study was to identify sociodemographic disparities in health care use among epilepsy patients receiving care at different sites and the extent to which the disparities persisted after adjusting for patient characteristics and site of care.


METHODS
Three months of health care use data were obtained from baseline interviews of approximately 560 patients at four sites. One-half of the patients were from a Houston site and two NYC sites that serve predominantly low-income, minority, publicly insured, or uninsured patients. The other half were at the remaining site in Houston that serves a more balanced racial/ethnic and higher sociodemographic population. Differences in general and specialist visits, hospital emergency room (ER) care, and hospitalizations were associated with race/ethnicity, income, and coverage. Logistic regression was used to assess the extent to which the differences persisted when adjusting for individual patient characteristics and site of care.


RESULTS
Compared to whites, blacks and Hispanics had higher rates of generalist visits [odds ratio (OR) = 5.3 and 4.9, p < 0.05), ER care (OR = 3.1 and 2.9, p < 0.05) and hospitalizations (OR = 5.4 and 6.2, p < 0.05), and lower rates of specialist visits (OR = 0.3 and 0.4, p < 0.05). A similar pattern was found related to patient income and coverage. The magnitude and significance of the disparities persisted when adjusting for individual characteristics but decreased substantially or were eliminated when site of care was added to the model.


CONCLUSIONS
There are sociodemographic disparities in health care for people with epilepsy that are largely explained by differences in where patients receive care.
Begley
Charles E
CE
The University of Texas, School of Public Health, Division of Management, Policy, and Community Health, Houston, Texas, USA. charles.e.begley@uth.tmc.edu
Basu
Rituparna
R
Reynolds
Thomas
T
Lairson
David R
DR
Dubinsky
Stephanie
S
Newmark
Michael
M
Barnwell
Forbes
F
Hauser
Allen
A
Hesdorffer
Dale
D
Hernandez
Nora
N
Karceski
Steven C
SC
Shih
Tina
T
D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D004827:Epilepsy / Q000453:epidemiology / Q000628:therapy; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009518:New York / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013781:Texas / Q000453:epidemiology