Health care disparities in morbidity and mortality in adults with acute and remote status epilepticus: A national study

Gabriela B. Tantillo, Deepa Dongarwar, Chethan P. Venkatasubba Rao, Amari Johnson, Stephanie Camey, Oriana Reyes, Mariana Baroni, Jaideep Kapur, Hamisu M. Salihu, Nathalie Jetté

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Although disparities have been described in epilepsy care, their contribution to status epilepticus (SE) and associated outcomes remains understudied. Methods: We used the 2010–2019 National Inpatient Sample to identify SE hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM codes. SE prevalence was stratified by demographics. Logistic regression was used to assess factors associated with electroencephalographic (EEG) monitoring, intubation, tracheostomy, gastrostomy, and mortality. Results: There were 486 861 SE hospitalizations (2010–2019), primarily at urban teaching hospitals (71.3%). SE prevalence per 10 000 admissions was 27.3 for non-Hispanic (NH)-Blacks, 16.1 for NH-Others, 15.8 for Hispanics, and 13.7 for NH-Whites (p <.01). SE prevalence was higher in the lowest (18.7) compared to highest income quartile (18.7 vs. 14, p <.01). Older age was associated with intubation, tracheostomy, gastrostomy, and in-hospital mortality. Those ≥80 years old had the highest odds of intubation (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.43–1.58), tracheostomy (OR = 2, 95% CI = 1.75–2.27), gastrostomy (OR = 3.37, 95% CI = 2.97–3.83), and in-hospital mortality (OR = 6.51, 95% CI = 5.95–7.13). Minority populations (NH-Black, NH-Other, and Hispanic) had higher odds of tracheostomy and gastrostomy compared to NH-White populations. NH-Black people had the highest odds of tracheostomy (OR = 1.7, 95% CI = 1.57–1.86) and gastrostomy (OR = 1.78, 95% CI = 1.65–1.92). The odds of receiving EEG monitoring rose progressively with higher income quartile (OR = 1.47, 95% CI = 1.34–1.62 for the highest income quartile) and was higher for those in urban teaching compared to rural hospitals (OR = 12.72, 95% CI = 8.92–18.14). Odds of mortality were lower (compared to NH-Whites) in NH-Blacks (OR =.71, 95% CI =.67–.75), Hispanics (OR =.82, 95% CI =.76–.89), and those in the highest income quartiles (OR =.9, 95% CI =.84–.97). Significance: Disparities exist in SE prevalence, tracheostomy, and gastrostomy utilization across age, race/ethnicity, and income. Older age and lower income are also associated with mortality. Access to EEG monitoring is modulated by income and urban teaching hospital status. Older adults, racial/ethnic minorities, and populations of lower income or rural location may represent vulnerable populations meriting increased attention to improve health outcomes and reduce disparities.

Original languageEnglish
JournalEpilepsia
DOIs
StateAccepted/In press - 2024

Keywords

  • gastrostomy
  • intubation
  • nationwide inpatient sample
  • seizure
  • tracheostomy

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