Mortality and Access to Comprehensive Epilepsy Care Among US Veterans
Abstract number :
2.329
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2021
Submission ID :
1825914
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Zulfi Haneef, MBBS, MD - Baylor College of Medicine; Rizwana Rehman - Durham VA Medical Center; Aatif Husain - Duke University
Rationale: The Veterans Health Administration (VHA) is the largest healthcare system in the country. Epilepsy in veterans have unique pathophysiologic and clinical characteristics1. Epilepsy Centers of Excellence (ECoE) provide comprehensive epilepsy care to veterans with epilepsy (VWE). We compared the mortality rates and access to ECoEs in VWE to civilian people with epilepsy (PWE).
Methods: Data from 10.1 million veterans within the VHA between FY2014-21 were analyzed. For classification purposes, VWE were defined as veterans who were prescribed ≥1 ASM for ≥30 days and a documented seizure diagnosis in the prior three years, while drug resistant epilepsy (DRE) was defined as ≥2 ASMs during this period. Access to comprehensive epilepsy care was defined as evaluation within the ECoE.
Results: DRE (n=60,557) accounted for 34.3% of all VWE (N=176,821). Most veterans with DRE were older (age 61.3±15.0 y), male (88.7%), White (White: 71.0%, Black 20.6%, Hispanic/Latino 5.7%), and urban (57.5%). During the study period, mortality among DRE was 23% (annualized mortality 3.0%). Among DRE, 13.8% were seen within an ECoE and 5.2% had EMU monitoring. TBI (28.4%) and PTSD (41.6%) were commonly encountered and was significantly more common in DRE than in VWE in general (15.8% and 24.1% respectively).2
Conclusions: DRE in VWE occurs at a similar rate to DRE in PWE. Veterans with DRE comprise a predominantly urban group of older white males. TBI and PTSD are more common in DRE than VWE in general. Annualized mortality rates among VWE (3.0%) were higher than civilian PWE (2.5%)3, and veterans in general (2.0%)4. Increasing access to comprehensive epilepsy evaluation may improve mortality and health outcomes among VWE.
Funding: Please list any funding that was received in support of this abstract.: None.
References
1. Pugh, M. J. V. et al. The prevalence of epilepsy and association with traumatic brain injury in veterans of the Afghanistan and Iraq wars. J Head Trauma Rehabil 30, 29–37 (2015).
2. Rehman, R., Kelly, P. R., Husain, A. M. & Tran, T. T. Characteristics of Veterans diagnosed with seizures within Veterans Health Administration. J Rehabil Res Dev 52, 751–762 (2015).
3. Sperling, M. R., Barshow, S., Nei, M. & Asadi-Pooya, A. A. A reappraisal of mortality after epilepsy surgery. Neurology 86, 1938–1944 (2016).
4. Barth, S. K., Kang, H. K. & Bullman, T. All-Cause Mortality Among US Veterans of the Persian Gulf War: 13-Year Follow-up. Public Health Rep 131, 822–830 (2016).
Health Services (Delivery of Care, Access to Care, Health Care Models)