The COVID-19 pandemic is changing the way we view health care. It has brought to the forefront of public conversation sobering truths about how social and racial disparities impact the health outcomes of underserved populations in the United States. Often, we attribute an individual’s health solely to the quality of health care they receive when in fact, a host of factors that occur outside clinical walls can play an even greater role in a person’s well-being. Social Determinants of Health (SDH) are the conditions in which people are born, grow, live, work and age, such as socioeconomic factors, housing, physical environment, education, employment, social support and access to health care. SDH can affect a wide range of health outcomes and quality of life, especially for individuals battling chronic illnesses like epilepsy.

New Research to Understand a Critical Gap in Epilepsy Care
To better understand how the impact of SDH manifests in epilepsy specifically, Arizona State University (ASU) College of Health Solutions and the Population Health Team at UCB, a global biopharmaceutical company focused on creating value for people living with severe diseases, are spearheading novel research to analyze the potential correlation between SDH and epilepsy health outcomes at a community level. This new study aims to uncover ways to better support patients so they can access appropriate treatments. As a clinical assistant professor at ASU and former employee at the Harvard Center for Women’s Health Policy, I have spent most of my career researching and teaching about social determinants, with a focus on how the lived experiences of individuals can result in disparate health outcomes. Through extensive research with my colleague Dr. Joseph Sirven, a professor of neurology at the Mayo Clinic, and the ASU-UCB project team, we have identified a remarkable absence of information about how factors other than health care can influence outcomes for epilepsy patients.
 

According to research published in Neurology, one-third of newly diagnosed epilepsy patients in the U.S. remain untreated with anti-seizure drugs for up to three years after diagnosis.¹ This is a significant treatment gap that increases the risk of medical events, emergency room visits and hospital admissions and can ultimately result in poor health outcomes. The epilepsy community has historically focused on epilepsy diagnoses as a key gap in care, but this study shows even patients with a confirmed diagnosis do not receive treatment in a timely manner. It is critical for the advancement of epilepsy care that we understand why. Studies of health disparities in conditions such as asthma — which like epilepsy is a chronic disease that often features acute episodes – have shown that SDH factors such as low socioeconomic status and poverty have an overwhelmingly negative impact on health outcomes. It is our hypothesis that the same may be true for patients with epilepsy.

Evaluating the Role of SDH in the Delay to Treatment for Epilepsy Patients

In Arizona, despite the great strides we have made in closing care gaps for people living with epilepsy, our community is a microcosm of national health care challenges — and in particular the staggering health disparities among socioeconomic, racial, ethnic and geographical groups. The ASU and UCB research will allow us to:

1.    Conduct a detailed analysis of SDH across the communities of Arizona.
2.    Create an algorithm and predictive statistical model to quantify relationships between SDH and epilepsy treatment delay in the Medicaid population.
3.    Build a digital interactive Geographic Information System (GIS) map to overlay SDH factors of interest with the gap between epilepsy diagnosis and treatment for each census tract in Arizona.

Our goal is to uncover key insights for a better understanding around what, if any, SDH are impacting the delay in treatment for some epilepsy patients. By overlaying community level data such as population density, environmental health, proximity to health care, diversity, school graduation rates, poverty, and unemployment, with Medicaid claims data about epilepsy diagnosis, physician specialty and where patients receive care, we can pinpoint which SDH are having the largest impact on health outcomes for patients.

Health disparities are currently one of the most complicated challenges in U.S. health care, and it takes partnerships across a variety of stakeholders to develop effective solutions. Our hope is this exciting research will provide actionable opportunities to close the gap in care related to epilepsy treatment delays. The research findings will allow UCB and others in the epilepsy community to not only fine-tune their approach to improving patient health outcomes, but also play a meaningful role in developing interventions that impact SDH factors influencing a patient’s ability to access the care that drives good health outcomes. Based on the success of the research in Arizona, there is potential to use this research model to evaluate and address the impact of SDH factors in epilepsy in other states — or even scaled nationally — and positively influence the journey of people living with epilepsy.

About the author: Swapna Reddy is a clinical assistant professor at Arizona State University's College of Health Solutions. She is also currently a doctoral candidate at the University of Texas School of Public Health. Reddy serves as faculty at Arizona State University’s Barrett, the Honors College (Medical Studies). Additionally, she is an adjunct assistant professor in Health Care Administration at the Mayo Clinic Alix School of Medicine- Arizona.
 

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1. L. Kalilani, E. Faught, H. Kim, C. Burudpakdee, A. Seetasith, S. Laranjo, D. Friesen, K. Haeffs, V. Kiri, D. Thurman. American Academy of Neurology. Assessment and effect of a gap between new-onset epilepsy diagnosis and treatment. April 10, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007448