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

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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.