Annual Meeting Abstracts: View

  • (Abst. 1.331), 2018
  • Longitudinal Predictors of Healthcare use in Adults With Epilepsy
  • Authors: Jesse Fishman, UCB Pharma; Boris Vabson, Stanford University; and Andrew N. Wilner, University of Tennessee Health Science Center
  • Content:

    Rationale: Few studies have examined how healthcare utilization and health outcomes in people with epilepsy change with age, and how socioeconomic factors affect this. Methods: This retrospective database analysis used inpatient and emergency department (ED) data from California, Florida, and New York for the 2003-2014 period, from the federal Healthcare Cost and Utilization Project. Eligible patients had an inpatient epilepsy diagnosis (at least one 345.xx ICD-9-CM code) in the 2-year identification period, with the index date corresponding to the date of first epilepsy diagnosis during this period. Inpatient and ED utilization data were examined over 4 years post-index. Inpatient and ED utilization were compared for patients aged < 15 vs those > 65 years. Impact of socioeconomic factors (eg. residence zip code) and demographic characteristics (gender and race) on healthcare utilization were analyzed. Descriptive statistics and Poisson multiple linear regression methodologies were used to calculate incidence rate ratios, which were adjusted for age category, insurance type, zip code income quartile, gender, and race. Results: The sample consisted of 95,584 epilepsy patients with a follow-up period of four years. Over the first year of follow-up, patients aged < 15 years (n = 10,246) had 2.57x (95% CI: 2.44 to 2.71) higher ED utilization and 15% (95% CI: 11% to 18%) lower inpatient utilization for all care, compared to those aged > 65 years (n=28,104). For epilepsy-specific care, those aged < 15 years had 7.79x (p=.001) higher ED utilization and 3.91x (p=.001) higher inpatient utilization, compared to those aged > 65 years.With respect to socioeconomic status, relative to those in top income quartile zip codes, epilepsy patients in bottom income quartile zip codes had 3.03x (p=.001) higher initial ER utilization and 7% (p=.001) higher inpatient utilization. For epilepsy-specific care, relative to those in the top income quartile, people with epilepsy in the bottom income quartile zip code had 2.65x (p=.001) higher ED utilization and 19% (p=.001) lower inpatient utilization.The gap between under 15 and over 65 utilization remained largely consistent over time, as those aged < 15 years had future ER utilization (3 years post) that was 2.09x (p=.001) higher overall and 7.39x (p=.001) higher for direct epilepsy care, relative to those > 65 years within the same time period. Compared to those in top income quartile zip codes, patients in the bottom income quartile zip codes had future ED utilization that was 26% (p=.001) higher overall and epilepsy-specific ED use that was 24% (p=.001) higher, even after accounting for other factors. Conclusions: For people with epilepsy, demographic and socioeconomic factors are associated with overall inpatient and ED utilization, as well as epilepsy-specific utilization. Patients <15 years old and those of lower socioeconomic status have higher baseline utilization, particularly for ED utilization. These utilization differences across age categories and socioeconomic groups remain intact over time, particularly when looking at utilization three years out. Funding: UCB Pharma-sponsored