Social Determinants of Health Predict Utilization Outcomes in Veterans with Post-traumatic Epilepsy
Abstract number :
3.136
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2024
Submission ID :
241
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Richard Zhou, BS – Baylor College of Medicine
Erin Sullivan-Baca, PhD – Neurocognitive Specialty Group
Thomas Bart, BS, MS – University of North Texas
Francisca Ahn, MD – Baylor College of Medicine
Zulfi Haneef, MBBS, MD – Baylor College of Medicine
Rationale:
Utilization of epilepsy care is crucial to promote epilepsy management and quality of life in epilepsy. Social determinants of health (SDoH) may play a role in access to healthcare and utilization of healthcare services. We examined a cohort of veterans with post-traumatic epilepsy (VWPTE) to examine how SDoH influence utilization outcomes.
Methods:
We utilized the VA Corporate Data Warehouse (CDW) to identify patients with epilepsy in calendar year 2022. VWPTE were then selected as those with records of a traumatic brain injury-related ICD code before epilepsy diagnosis. SDoH variables examined included age, sex, race, and number of unique SDoH-related ICD diagnosis codes. Utilization measures included use of VA neurology and epilepsy centers of excellence (ECoE) clinics, use of EEG, MRI brain, or CT head, total inpatient stay length and ED visits for seizure-related diagnoses, and number of unique anti-seizure medications (ASM) prescribed. Elixhauser comorbidity index and length of epilepsy diagnosis were included in the models as adjusters. Multivariable regression models were used to assess the association between SDoH variables and utilization outcomes.
Results:
Of 67,852 epilepsy patients in calendar year 2022, 3,380 (4.98%) were VWPTE. Descriptive statistics for the cohort are provided in Table 1. The total number of unique SDoH-related diagnoses was significantly associated with a higher likelihood of ECoE clinic utilization, having a CT, MRI, or EEG, longer inpatient hospitalization, more ED visits, and greater number of ASM prescriptions. Older age was generally significantly associated with lower utilization. Males had less neurology clinic visits and less ASM usage overall. Specific results are presented in Table 2. There were no significant differences in utilization based on race.
Conclusions:
In the VA, overall utilization of epilepsy care in the VWPTE group is positively associated with more SDoH risk factors, suggesting adequate coverage of at-risk individuals. The influence of age and sex on utilization vary, although overall effect sizes are small. Race does not influence utilization.
Funding: None
Health Services (Delivery of Care, Access to Care, Health Care Models)