Economic instability, food insecurity, social isolation, and inadequate access to care in adults with epilepsy: A nationwide analysis

Abstract

Background: Social needs of health, such as economic instability, food insecurity, social isolation, and inadequate access to care, significantly impact health outcomes and quality of life. People with epilepsy may face heightened challenges in these areas, but the extent of such disparities is not fully understood. This study investigates the association between epilepsy and economic instability, food insecurity, social isolation, and inadequate access to care to identify significant social and economic disparities impacting patient care.

Methods: A cross-sectional analysis of adult participants from the 2021 National Health Interview Survey was conducted. The primary outcomes were economic instability, food insecurity, social isolation, and inadequate access to care. Participants were categorized as having active epilepsy (currently receiving treatment), inactive epilepsy (diagnosed but not receiving treatment), or no epilepsy. Univariable and multivariable logistic regressions were performed to assess associations between presence of epilepsy and social needs of health after controlling for age, sex, race, region, marriage/living status, education, insurance, and number of comorbidities. Factors contributing to disparities within the active epilepsy group were also analyzed.

Results: Of 26,794 participants, 240 (0.90 %) reported active epilepsy, 212 (0.79 %) inactive epilepsy, and 26,342 (98.3 %) no epilepsy. Compared to individuals with no epilepsy, those with active epilepsy had significantly higher rates of economic instability (81 % vs. 46 %; p < 0.001), food insecurity (37 % vs. 20 %; p < 0.001), social isolation (37 % vs. 8 %; p < 0.001), and inadequate access to care (88 % vs. 56 %; p < 0.001). Multivariable analyses confirmed these associations, with disparities also observed among individuals with inactive epilepsy. Factors such as age, race, marital status, education, and comorbidities were significantly associated with social needs of health among those with active epilepsy.

Significance: People with epilepsy experience substantial social and economic challenges, emphasizing the urgent need for targeted interventions to address these inequities and improve outcomes.

Keywords: Epilepsy; Health Outcomes; Health equity; Social needs of health; Survey.