The effects of social determinants of health on patients with epilepsy

Social determinants of health (SDoH) are critical in influencing healthcare access and outcomes. Patients with epilepsy often face unique barriers, however most interventions rely on broad socioeconomic status (SES) markers, which may not capture individual needs and could misguide resource allocation.

This retrospective cohort study analyzed epilepsy patients' SDoH data and healthcare utilization from one large heath network. SDoH needs were evaluated across multiple domains, while primary outcomes included rates of healthcare encounters, procedures performed, and mortality. Secondary analysis compared the effect of SDoH needs with that of race and insurance type.

A total of 2,984 patients with an SDoH assessment from 2022 to 2023 were included (mean age of 56.8 years,55.4 % female). Among the cohort, 54.0 % reported no SDoH needs, 24.8 % moderate needs, and 21.2 % significant needs. Greater SDoH needs were associated with increased healthcare encounters, particularly ED and office visits, without a proportional increase in neurology visits. In adjusted models, patients with moderate and significant needs had a lower likelihood of survival by study end, with odds ratios of 0.39 [95 % CI, 0.27-0.57] and 0.54 [95 % CI, 0.35-0.84], respectively, compared to those with no needs. African American patients and those with non-commercial insurance were found to have higher ED use and fewer neurology visits, highlighting disparities.

This patient-reported SDoH assessment can identify and stratify high-risk individuals, revealing treatment gaps for targeted interventions. Furthermore, the SDoH assessments revealed trends not captured by traditional SES measures, further underscoring the importance of individual SDoH need in managing patients with epilepsy.