Abstracts

Rationale: Availability of high-quality epilepsy care is crucial to improve clinical outcomes of patients with epilepsy. This ecological cross-sectional study examined the spatial and demographic nature of availability of NAEC Accredited Epilepsy Centers, adult epileptologists, and neuropsychologists with a specialization in epilepsy across two counties in New York City: Kings County (Brooklyn) and New York County (Manhattan). Specifically, we compared social vulnerability factors and availability of epilepsy providers in the state of New York at the county level. Social vulnerability factors are environmental and social factors related to multiple social determinants of health that are posited to be major causes of health inequalities. The Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (CDC/ATSDR) Social Vulnerability Index (SVI) was developed to determine these social vulnerability characteristics at the county and census tract level. By using such a metric, we can be better informed about the characteristics of communities at an aggregate level and assess patterns across communities.


Methods: Number of NAEC Accredited Epilepsy Centers, adult epileptologists, and neuropsychologists specialized in epilepsy were identified Manhattan and Brooklyn (Table 1). Then, population estimates were collected for variables of interest from the 2020 CDC/ATSDR SVI for each county for exploration and analysis (Table 1). The CDC/ATSDR SVI data will be mapped by census tract and linked with the location of NAEC Accredited Adult Epilepsy Centers and providers.


Results: Despite being smaller by population and area, Manhattan had substantially more providers than Brooklyn across all data collected. There were 3 times as many accredited epilepsy centers, 3.3 times as many neuropsychologists, and 4.3 times as many adult epileptologists. At the same time, Brooklyn residents were more vulnerable than Manhattan ones across all sociodemographic factors examined (Table 1). For example, Brooklyn had approximately twice as many residents with no high school diploma, below the 150% poverty level, uninsured, minority, and with limited English. Finally, Brooklyn ranked as the second overall most vulnerable county in New York state according to the SVI, whereas Manhattan ranked 15^th.


Conclusions: Differences in the sociodemographic characteristics of communities may help inform more equitable strategies from public health departments to mitigate disparities in epilepsy care. This includes information about areas to direct resources and ways to incentivize training and retention of specialist practitioners in underserved communities. This comparative analysis also highlights the need to extensively examine community characteristics across the U.S. and the need for deeper understanding of factors that may make some communities more vulnerable to limited or inadequate access to quality epilepsy care.


Funding: No funding.