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Rural-Urban Disparities in Epilepsy Outcomes in the United States
Edward R Bader1, William S Kemball-Cook1, Joshua A Benton1
1Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY; and.
Neurology
|June 3, 2026
Summary
Living in rural areas is linked to worse epilepsy outcomes, including nearly double the risk of in-hospital mortality. These disparities may stem from structural barriers, not just geography.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- Rural populations face challenges accessing neurologists and specialized epilepsy care.
- The impact of rural residence on epilepsy clinical outcomes is not well understood.
Purpose of the Study:
- To assess the association between rurality and epilepsy outcomes in a US national cohort.
- To identify disparities in epilepsy care and outcomes based on geographic location.
Main Methods:
- Retrospective cohort study using the National Inpatient Sample (2016-2021).
- Analysis of 841,445 epilepsy admissions, classifying patients by rurality.
- Logistic regression models adjusted for demographics, socioeconomic factors, and comorbidities.
Main Results:
- Rural patients had higher odds of in-hospital mortality (OR 1.93), status epilepticus (OR 1.32), and prolonged hospital stay (OR 1.29).
- Rural patients had lower odds of receiving EEG (OR 0.88) and nonroutine discharge (OR 0.90).
- Disparities in mortality, status epilepticus, and prolonged stay were not observed in privately insured patients.
Conclusions:
- Increasing rurality is associated with significantly worse epilepsy outcomes.
- Structural barriers, potentially related to insurance, appear to drive rural-urban disparities.
- Targeted public health interventions are needed to improve care for rural epilepsy patients.
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