Abstracts

Rationale: Epilepsy has a higher prevalence in children from lower socio-economic status (SES) than higher SES. It is unknown if there is a disparity in health resource utilization (HRU) among children with epilepsy, particularly in the setting of a universal health system where equal access to care is assumed. This population-based study examined the influence of SES on HRU among children with epilepsy in a universal health insurance system. Additionally, we evaluated whether access to neurology specialty care reduced emergency department (ED) visits and hospitalizations.Methods: Health administrative databases from the Institute of Clinical Evaluative Sciences (ICES) were used to identify HRU among children with epilepsy (aged 0-18 years) in the province of Ontario, Canada. The frequency of neurologist visits as well as overall and epilepsy-related ED visits and hospitalizations were evaluated for the year 2013. Two measures of SES were utilized: residential neighbourhood income and deprivation index, which measures both material and social deprivation. The association between SES and HRU was assessed, controlling for age, sex, comorbidities and residence (urban vs. rural). Subsequently, we assessed if the number of neurology visits influenced ED visits and hospitalizations, controlling for age, sex, comorbidities, residence and SES.Results: 19,035 children (mean age 11.58 years) were identified, of which 54.6% were male and 11.3% lived in a rural residence. Deprivation index was a more sensitive measure of the disparity in HRU than neighbourhood income. Lower SES was associated with 15% fewer neurology visits, 36% and 45% more frequent overall and epilepsy-related ED visits respectively, and 27% more frequent overall hospitalizations. Increased neurology visits were associated with more frequent ED visits (11% and 18% increased for overall and epilepsy-related ED visits respectively) and hospitalizations (15% and 18% increased for overall and epilepsy-related hospitalizations respectively).Conclusions: Although it is assumed that a universal health insurance system would ensure equal access to healthcare resources, we demonstrated that disparity in HRU was evident in children with epilepsy. We also found that increased neurology visits were associated with higher ED visits and hospitalizations, which could reflect increased seizure severity in children who were referred to neurologists.