1. Epilepsia. 2009 May;50(5):1040-50. doi: 10.1111/j.1528-1167.2008.01898.x. Epub
2008 Nov 17.

Sociodemographic disparities in epilepsy care: Results from the Houston/New York 
City health care use and outcomes study.

Begley CE(1), Basu R, Reynolds T, Lairson DR, Dubinsky S, Newmark M, Barnwell F, 
Hauser A, Hesdorffer D, Hernandez N, Karceski SC, Shih T.

Author information: 
(1)The University of Texas, School of Public Health, Division of Management,
Policy, and Community Health, Houston, Texas, USA. charles.e.begley@uth.tmc.edu

PURPOSE: The purpose of this study was to identify sociodemographic disparities
in health care use among epilepsy patients receiving care at different sites and 
the extent to which the disparities persisted after adjusting for patient
characteristics and site of care.
METHODS: Three months of health care use data were obtained from baseline
interviews of approximately 560 patients at four sites. One-half of the patients 
were from a Houston site and two NYC sites that serve predominantly low-income,
minority, publicly insured, or uninsured patients. The other half were at the
remaining site in Houston that serves a more balanced racial/ethnic and higher
sociodemographic population. Differences in general and specialist visits,
hospital emergency room (ER) care, and hospitalizations were associated with
race/ethnicity, income, and coverage. Logistic regression was used to assess the 
extent to which the differences persisted when adjusting for individual patient
characteristics and site of care.
RESULTS: Compared to whites, blacks and Hispanics had higher rates of generalist 
visits [odds ratio (OR) = 5.3 and 4.9, p < 0.05), ER care (OR = 3.1 and 2.9, p < 
0.05) and hospitalizations (OR = 5.4 and 6.2, p < 0.05), and lower rates of
specialist visits (OR = 0.3 and 0.4, p < 0.05). A similar pattern was found
related to patient income and coverage. The magnitude and significance of the
disparities persisted when adjusting for individual characteristics but decreased
substantially or were eliminated when site of care was added to the model.
DISCUSSION: There are sociodemographic disparities in health care for people with
epilepsy that are largely explained by differences in where patients receive
care.

DOI: 10.1111/j.1528-1167.2008.01898.x 
PMID: 19054413  [Indexed for MEDLINE]