title: Socioeconomic status, health care use, and outcomes: persistence of disparities over time.
abstract: OBJECTIVE
  To determine the persistence of disparities in health care use and outcomes in socioeconomically diverse populations of epilepsy patients.
  
  
  METHODS
  We followed patients for a year at one clinic in Houston and two in New York City that serve predominantly low-income, minority, Medicaid-insured, or uninsured patients, and a fourth clinic in Houston that serves a more balanced racial/ethnic and higher socioeconomic status (SES) population. We interviewed the patients several times regarding health care use, seizures, side effects, and outcomes, and examined differences between the patients at the three low-SES clinics and the patients at the high-SES clinic.
  
  
  RESULTS
  After controlling for patients' age, gender, race/ethnicity, marital status, seizures, and side effects we found that low SES patients had consistently higher use of the hospital emergency room and more visits to a general practitioner. Hospitalizations were also consistently higher but the differences were not significant in most periods. Neurologist visits were relatively similar. Patients at the low SES sites also had a greater likelihood of having uncontrolled seizures, drug-related side effects, to be stigmatized, and have a lower overall quality of life throughout the study period.
  
  
  CONCLUSIONS
  These findings suggest the persistence of SES-related disparities in health care use and outcomes among patients with epilepsy who are receiving regular care.
authors.affiliation: University of Texas, School of Public Health, Division of Management, Policy, and Community Health, Houston, Texas, USA. charles.e.begley@uth.tmc.edu
authors.forename: Charles
authors.initials: C
authors.lastname: Begley
authors.forename: Rituparna
authors.initials: R
authors.lastname: Basu
authors.forename: David
authors.initials: D
authors.lastname: Lairson
authors.forename: Thomas
authors.initials: T
authors.lastname: Reynolds
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dubinsky
authors.forename: Michael
authors.initials: M
authors.lastname: Newmark
authors.forename: Forbes
authors.initials: F
authors.lastname: Barnwell
authors.forename: Allen
authors.initials: A
authors.lastname: Hauser
authors.forename: Dale
authors.initials: D
authors.lastname: Hesdorffer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D008913:Minority Groups; D009819:Office Visits / Q000706:statistics & numerical data; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome