title: The influence of socioeconomic status on health resource utilization in pediatric epilepsy in a universal health insurance system.
abstract: OBJECTIVE
  It is unknown if there is a disparity in health resource utilization (HRU) among children with epilepsy in a universal health insurance system. The aims of this study were to evaluate whether socioeconomic status (SES) influenced the pattern of HRU among children with epilepsy, and to determine if neurology visits were associated with emergency department (ED) visits and hospitalizations.
  
  
  METHODS
  Health administrative databases were used to identify HRU among children with epilepsy in Ontario, Canada. The frequency of neurology visits, ED visits, and hospitalizations were assessed for 1 year. SES was measured using dissemination area income and deprivation index. The association between SES and HRU was evaluated, adjusting for age, sex, residence, and comorbidities. Subsequently, we assessed whether neurology visits influenced ED visits and hospitalizations, adjusting for age, sex, residence, comorbidities, and SES.
  
  
  RESULTS
  Deprivation index was a more sensitive measure of disparity in HRU than dissemination area income. Status epilepticus-related ED visits and hospitalizations were most expensive but accounted for a small proportion of total costs. Higher deprivation was associated with fewer neurology visits (relative risk [RR] 0.85-0.89), more frequent ED visits (RR 1.08-1.36), and hospitalizations (RR 1.27). Increased neurology visits were associated with more frequent ED visits (RR 1.10) and hospitalizations (RR 1.15). The associations between neurology visits and ED visits as well as hospitalizations varied by deprivation index, in that neurology visits were associated with increased ED visits and hospitalizations and the increase was higher in the most deprived relative to the least deprived (all p < 0.0001).
  
  
  CONCLUSIONS
  We found disparity in HRU by SES despite the universal health insurance system. More frequent neurology visits were associated with more frequent ED visits and hospitalizations after adjusting for SES, probably related to epilepsy severity. Our study identified an at-risk population for high resource use that may require additional support to reduce ED visits and hospitalizations.
authors.affiliation: Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Klajdi
authors.identifier: http://orcid.org/0000-0001-7763-988X
authors.initials: K
authors.lastname: Puka
authors.affiliation: Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada.|Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Smith
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: O Carter
authors.initials: OC
authors.lastname: Snead
authors.affiliation: Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.|Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Elysa
authors.initials: E
authors.lastname: Widjaja
mesh_terms: D000293:Adolescent; D002648:Child; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D004827:Epilepsy / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors; D019472:Universal Health Insurance / Q000191:economics* / Q000706:statistics & numerical data*
keywords: Children; Deprivation index; Dissemination area income; Population study