Frequent seizure and epilepsy-related emergency department visits in the United States: A retrospective cohort study.

Objectives: Health disparities impact access to epilepsy care in the United States, but how these factors contribute to recurrent emergency department (ED) visits is unclear. We hypothesized that people who (1) were uninsured or had public health insurance, (2) belonged to minoritized racial/ethnic groups, or (3) resided in low-income zip codes were more likely to have frequent ED visits for seizure or epilepsy.

Methods: This was a retrospective cohort study of adult patients presenting to the ED in four U.S. states (Florida, Maryland, New York, and Wisconsin) with a primary diagnosis of seizure or epilepsy. We tracked ED visits for each patient longitudinally between 2016 and 2018. We performed a multivariable logistic regression analysis evaluating the association of the above factors with a high (>2) vs low (1-2) number of ED visits.

Results: We identified 200 962 patients who visited the ED for seizure/epilepsy, of whom 28 598 (14.7%) presented 2 times during the study period. Compared to private insurance, individuals with Medicare (adjusted odds ratio [aOR] 1.90, 95% confidence interval [CI]: 1.82-1.99), Medicaid (aOR 2.01, 95% CI: 1.93-2.09), or no insurance (aOR 1.55, 95% CI: 1.48-1.62) had increased odds of high ED visits. Black patients had a 60% higher odds of frequent ED visits compared with White patients (aOR 1.60, 95% CI: 1.55-1.65). However, these disparities were attenuated for Black patients with Medicare and Medicaid, vs private insurance. High ED use was not seen in other racial/ethnic groups. Finally, patients living in low-income zip codes (0-25th percentile of median household income; aOR 1.65, 95% CI: 1.58-1.73) were more likely to be in the high ED visit group, compared with the highest income quartile.

Significance: Racial/ethnic and socioeconomic inequities likely contribute to frequent ED visits for seizures, as evidenced by our findings from four U.S. states. Effective, multi-level interventions are needed to reduce disparities for those most affected.