Epilepsy-associated labor force exclusion in a multi-ethnic neurology cohort

Employment is a key marker of independence, quality of life, and socioeconomic stability. People with epilepsy may face employment barriers related to seizure burden, psychiatric comorbidity, stigma, and workplace constraints. Few studies have evaluated employment outcomes using a contemporaneous same-practice specialty-neurology comparator.

We performed a retrospective cross-sectional study of adults evaluated at Hawaii Pacific Neuroscience between January 2019 and January 2020; retrospective chart abstraction was conducted from January through July 2020. The analytic cohort included NHPI, Asian, and White patients with documented employment status (n = 850; epilepsy n = 403; comparator n = 447). Recorded labor-force exclusion was defined as unemployed or disabled versus employed. Conventional multivariable logistic regression evaluated clinical and demographic correlates; stroke-adjusted, stroke-excluded, and outcome-specific sensitivity analyses were performed.

Epilepsy patients were less often employed than comparator patients (28.3% vs 49.2%, p < 0.001), more often unemployed (34.5% vs 18.1%, p < 0.001), and more often disabled (10.2% vs 3.1%, p < 0.001). Recorded labor-force exclusion was present in 44.7% versus 21.3%, respectively (p < 0.001). In the primary adjusted model, epilepsy (OR 3.48, 95% CI 2.45-4.94), any psychiatric diagnosis (OR 2.04, 95% CI 1.44-2.89), and current smoking (OR 1.65, 95% CI 1.04-2.60) were associated with labor-force exclusion. The epilepsy association persisted after adjustment for documented stroke (OR 3.28, 95% CI 2.30-4.67) and after exclusion of participants with stroke (OR 3.21, 95% CI 2.21-4.66).

In this single-center specialty-neurology cohort, epilepsy was associated with lower documented employment and higher recorded unemployment or disability than a contemporaneous comparator with other neurological conditions. These cross-sectional findings should be interpreted in the context of a clinically selected referral population and unmeasured neurological, functional, occupational, and socioeconomic factors.