Understanding the Disparities in Emergency Department Visits for Seizures
A recent study has highlighted significant disparities in emergency department (ED) visits among individuals with seizures or epilepsy, particularly among racial and ethnic minorities and those from lower socioeconomic backgrounds. The findings, published in the journal Epilepsia, reveal that factors such as insurance status, race, and income level play a critical role in determining how often patients seek emergency care.
Key Findings of the Study
The research, led by Dr. Brad K. Kamitaki from Rutgers-Robert Wood Johnson Medical School, involved a retrospective cohort study of over 200,000 adult patients who visited the emergency department for seizure-related issues across four U.S. states. The study aimed to determine whether certain groups were more likely to have frequent ED visits.
Out of the total participants, 14.7% had two or more visits during the study period. The results showed that individuals without insurance or those with public health coverage, such as Medicare or Medicaid, had significantly higher odds of frequent emergency department use compared to those with private insurance. Specifically, the adjusted odds ratios were 1.90 for Medicare, 2.01 for Medicaid, and 1.55 for those without insurance.
Racial and Ethnic Disparities
When comparing different racial and ethnic groups, Black patients were found to have a higher likelihood of frequent ED visits, with an adjusted odds ratio of 1.60. However, this disparity was less pronounced among Black patients who had Medicare or Medicaid coverage. This suggests that access to public health insurance may help reduce some of the inequities experienced by minority populations.
Other racial and ethnic groups did not show similar patterns of increased ED use, indicating that the issue is not universal across all communities. This highlights the need for targeted interventions that address the specific challenges faced by Black patients.
Socioeconomic Factors
In addition to race, socioeconomic status also played a significant role in determining ED visit frequency. Patients living in low-income zip codes—those in the lowest 25th percentile of median household income—were more likely to be in the high ED visit group, with an adjusted odds ratio of 1.65. This underscores the impact of economic hardship on healthcare access and utilization.
Addressing Systemic Challenges
The researchers emphasized that the root causes of these disparities are deeply embedded in societal structures. Factors such as poverty, healthcare costs, and systemic racism require comprehensive solutions that go beyond the scope of individual healthcare providers. They called for a multisectoral approach involving policymakers, community organizations, and healthcare professionals to create meaningful change.
Clinicians and researchers can contribute by advocating for their patients, engaging with policymakers to influence health policy, and developing evidence-based strategies to tackle these complex issues. By working together, stakeholders can help ensure that all individuals, regardless of their background, have equitable access to quality healthcare.
Conclusion
The findings of this study highlight the urgent need to address the underlying social determinants of health that contribute to disparities in emergency care for seizures and epilepsy. While the role of healthcare providers is important, lasting change will require collaboration across multiple sectors to create a more just and equitable healthcare system.
