Evaluating and Quantifying the Magnitude and Multilevel Causes of Health Disparities in Understudied Minority People with Epilepsy (EQU-ity)

项目摘要/摘要 由于个体的相互作用，种族和少数民族人口的健康差距是复杂的。 合并症和种族/民族)、治疗(例如，学术、多专业中心)和社区层面的因素 (例如，农村/城市的服务提供情况)。对于处于这些因素交汇点的个人，例如农村 有高共病特征的西班牙裔个体，我假设他们的结果不仅比一般人差 人口，但比其他西班牙裔个人更差。这些类型的种群通常很难研究，因为 样本量小或同质性(组内)使分析和解释受到限制或接近 不可能。 以癫痫为例，拥有最大和最具种族、民族和地理多样性的 关于癫痫患者(PWE)的现有数据本提案旨在建立在先前在以下领域的工作的基础上 健康差距研究。据估计，美国有340万人患有癫痫(6500万人 全球)，并需要由专业神经科医生进行治疗，进行广泛的诊断测试和 药物疗法。这种疾病对美国医疗保健行业有重大影响；据估计 表明每年的成本超过150亿美元。PWE经历了过早死亡的高风险，以及 在学校、社会关系、就业、交通和独立生活方面面临严重挑战，还有更多 超过一半的PWE患者有多种慢性身体和/或精神疾病。面对这些挑战， 在日常生活中，PWE更容易受到不良健康结果的影响。 在最新可用的多状态上使用传统和新的统计和数据挖掘技术 医疗补助数据I将能够识别少数人和多数人之间的差异 在监测人群中，在健康结果中，量化条件的星座，并确定哪些 最重要的因素是导致负面健康事件的因素，如住院和较长时间 留下来。这项研究将侧重于历史上服务不足和以前研究不足的PWE，例如 拉美裔、美洲原住民和那些生活在农村地区的人，包括那些患有难治性癫痫的人。这些 分析将包括个人、治疗和社区层面的多层次组合，从而允许 更深入地理解这些差距是如何出现的。在我们的17个州的数据库中，我识别了超过 67万癫痫或癫痫患者，包括超过14.7万名黑人，8万名西班牙裔，5000名土著 美国人，36.8%的县覆盖农村。 这项工作不仅将告知癫痫患者预后的差异，而且还将有助于 展示这种结合了传统分析和新分析的分析方法的优势和劣势 将健康差距概念化和量化的方法。这份建议书将提供基础知识 需要制定和部署干预措施，以减少健康差距。

Project Summary/Abstract Health disparities for racial and ethnic minority populations are complex due to the interplay of individual (e.g. comorbidities and race/ethnicity), treatment (e.g. academic, multi-specialty centers), and community level factors (e.g. availability of services, rural/urban). For individuals at the intersection of these factors, such as rural Hispanic individuals with a high comorbidity profile, I posit that their outcomes are not only worse than the general population, but worse than other Hispanic individuals. These types populations are often difficult to study due to small sample sizes or homogeneity (within the group) making analysis and interpretation limited – or near impossible. Using epilepsy as a case study, with one of the largest and most racially, ethnically, and geographically diverse data available on people with epilepsy (PWE) this proposal seeks to build upon previous work in the field of health disparities research. Epilepsy is estimated to affect 3.4 million people in the United States (65 million worldwide) and requires treatment by specialized neurologists, with extensive diagnostic testing and pharmacotherapy. This disease has a significant impact on the United States healthcare industry; with estimates indicating an annual costs of over $15 billion. PWE experience a high risk of premature mortality, as well as serious challenges in school, social relationships, employment, transportation, and independent living, with more than half of PWE having multiple chronic physical and/or psychiatric conditions. With these challenges in everyday life, PWE are at a heightened vulnerability for poor health outcomes. Using both traditional and novel statistical and data mining techniques on the most recently available multi-state Medicaid claims data I will be able to identify disparities, both between minority and majority populations as well as within monitory populations, in health outcomes, quantify constellations of conditions, and identify which factors are most important in contributing to negative health events, such as hospitalizations and longer length of stay. This study will have an emphasis on historically underserved and previously understudied PWE such as Hispanics, Native Americans, and those living in rural areas, including those with refractory epilepsy. These analyses will include multi-level combinations at the individual, treatment, and community level allowing for a deeper understanding of how these disparities emerge. In our database of 17 states I have identified over 670,000 people with seizure or epilepsy including over 147,000 Black individuals, 80,000 Hispanics, 5,000 Native Americans, with 36.8% of the counties covered being rural. This work will inform not just the disparities in outcomes for people living with epilepsy, but also serves to demonstrate the strengths and weakness of this analytic approach which combines traditional and novel analytic methods to conceptualize and quantify health disparities. This proposal will provide the foundational knowledge needed to develop and deploy interventions to reduce health disparities.