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

Abstract

AbstractObjectiveAlthough disparities have been described in epilepsy care, their contribution to status epilepticus (SE) and associated outcomes remains understudied.MethodsWe 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.ResultsThere 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).SignificanceDisparities 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.