Disparities Associated with Discontinuation of Ketogenic Diet Therapy: Single Center Experience
Abstract number :
3.339
Submission category :
10. Dietary Therapies (Ketogenic, Atkins, etc.)
Year :
2022
Submission ID :
2204533
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Erin Fedak Romanowski, D.O. – CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; Renee Shellhaas, MD, MS – Clinical Professor of Pediatrics, Pediatric Neurology Division, Pediatrics Department, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; Sarah Hall, MS, BS – Clinical Research Coordinator, Pediatric Neurology Division, Pediatrics Department, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; Sohini Pandit, BS – Clinical Research Coordinator, Pediatric Neurology Division, Pediatrics Department, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; Stephanie Rau, B.S., C.C.R.P. – Clinical Research Project Manager, Pediatric Neurology Division, Pediatrics Department, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; Julie Sturza, MPH – Statistician Lead, Department of Biostatistics and Data Management, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; Samantha Choi, MS, RDN, CSP – Ketogenic Diet Dietitian, Patient Food and Nutrition Services, C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan Health; Rebecca Thorwall, MS, RDN – Ketogenic Diet Dietitian, Patient Food and Nutrition Services, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; J. Paige Rieckhoff, CPNP-AC – Pediatric Epilepsy Nurse Practitioner, Pediatric Neurology Division, Pediatrics Department, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; Russell Derry, MPH – Pediatric Epilepsy Program Coordinator, Pediatric Neurology Division, Pediatrics Department, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; Krause Marie, LMSW – Pediatric Neurology Social Worker, Department of Social Work, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan; Sucheta Joshi, MD, MS – Clinical Professor of Pediatrics, Pediatric Neurology Division, Pediatrics Department, CS Mott Children's Hospital, Michigan Medicine Health, University of Michigan
This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session
Rationale: Ketogenic diet (KD) therapy consists of a high fat, moderate protein, low carbohydrate diet. KDs have been shown to reduce seizure frequency by >50% in approximately 50% of children with refractory epilepsy. Adherence to the KD can be challenging, and often requires significant medical and social support. We aimed to assess possible disparities associated with early discontinuation of the KD at our Level IV Pediatric Epilepsy Center.
Methods: Data were drawn from a prospective database of all children treated with the KD from October 2014 through February 2022. Every child was enrolled, and outcomes were recorded at 1, 3, 6, 9, and 12 months after KD initiation. A discrete-time logistic model using backward elimination examined the associations of patient characteristics with time to KD discontinuation. To evaluate for disparities impacting KD continuation, patient characteristics included for analysis were sex, race/ethnicity, age at diet initiation, insurance type (public, private, or both; all children with epilepsy in our state are eligible for supplemental public insurance), family structure, and tube feeding (Table 1). Survival analysis was performed to analyze time on the KD (assessed at 1, 3, 6, 9, and 12 months after initiation). This was reported as conditional probability, probability of continuation, and probability of discontinuation.
Results: We included 208 consecutive children (Table 1). Insurance type was the only variable associated with time to KD discontinuation; children with combined public AND private insurance were most likely to continue the KD while children with public insurance only were least likely to stay on the KD over time (Figure 1). Our patient cohort demographics were relatively similar in terms of race/ethnicity when compared to the general population in Michigan. Based on US Census data, Michigan race/ethnicity was as follows: White (Non-Hispanic) (74.7%), Black or African American (Non-Hispanic) (13.5%), White (Hispanic) (3.56%), Asian (Non-Hispanic) (3.26%), and Two+ (Non-Hispanic) (2.64%).
Conclusions: Children who require public insurance are subject to healthcare inequities. Here, we show that having only public insurance was a risk for early KD discontinuation among a consecutive cohort of children treated at a Level IV Pediatric Epilepsy Center. Protocols for treatment did not differ explicitly according to insurance. We hypothesize that socioeconomic factors related to insurance coverage (e.g. food security, income, education level, employment status, medical literacy, transportation) contributed to difficulties maintaining the KD for families who rely on public health insurance for their children with epilepsy. This finding suggests a potential inequity in health care delivery. Systematic evaluation of supports and challenges for low-income families of children with epilepsy could lead to solutions to minimize healthcare inequities.
Funding: None
Dietary Therapies (Ketogenic, Atkins, etc.)