Abstracts

Rationale: While the literature on disparities in epilepsy has grown, comprehensive comparative data remain limited, and most of the literature has not focused on the needs of rural communities. The University of Iowa Hospitals and Clinics (UIHC) is surrounded by a uniform distribution of mid-sized cities without a dominant metropolitan center and serves a high proportion of patients from rural areas. An evaluation of healthcare outcomes of epilepsy patients at UIHC based on the 2013 Rural-Urban Continuum Codes (RUCC) was conducted to better understand the needs of the rural epilepsy population.

Methods: We performed a retrospective electronic medical record (EMR) review of adult patients presenting to UIHC with an epilepsy diagnosis from January of 2016 through January of 2021. Patients were identified using the SlicerDicer tool available in the EPIC EMR. Inclusion criteria included a diagnosis of epilepsy or recurrent seizures with an ICD-10 code of G40., prescription of a seizure medication, and an age between 18 and 89 years. 5% of the charts were reviewed by 3 neurologists to confirm the diagnosis of epilepsy._x000D_ Data on healthcare outcomes including emergency department visits, hospitalizations, and death, were collected. Quality measures in epilepsy care were evaluated including a neurologist visit in the last year or having an MRI of the brain or EEG over the 5-year period. Comorbidities were evaluated by collecting information on ICD codes for falls and burns.  Comparisons were made by level of rurality as assessed by RUCC for differences between health outcomes. _x000D_
Results: A total of 5262 patients were identified based on review of the EMR. 94% of the charts reviewed confirmed a diagnosis of epilepsy. The cases that did not have epilepsy had functional neurologic disorder (FND), provoked seizures, or post cardiac arrest myoclonus. 2972 patients were from metropolitan areas (RUCC 1-3), and 2290 patients were from rural areas (RUCC 4-9). The mean age of rural epilepsy patients was older at 50.2 years, when compared to the age of metropolitan epilepsy patients at 47 years._x000D_ Patients in rural communities were less likely to see a neurologist with 27% of metropolitan patients seeing a neurologist in the last year compared to 24% of rural patients. However, other outcomes were not significantly different with 9% of rural and metropolitan patients having an emergency department visit and 12-13% dying. A similar number of patients in rural and urban communities had testing with MRIs (17%) and EEGs (33%) and experienced complications such as falls (13-14%) and burns (1-2%).

Conclusions: Compared to urban dwellers, rural people with epilepsy tended to be older and were less likely to see a neurologist, but other measured outcomes were similar between the two groups. This study is limited by being a retrospective review of data from one institution and further study of disparities in health outcomes for people with epilepsy from rural communities needs to be conducted. The lack of neurologists in rural areas may impact health outcomes in epilepsy patients which were not evaluated in this review.

Funding: Supported by Cooperative Agreement Number 6 U48DP006389 from the Centers for Disease Control and Prevention.