Socioeconomic status and healthcare resource disparities among children with epilepsy in the United States: Results from a nationally representative sample

Rationale Epilepsy affects 1% of the US population. Healthcare and socioeconomic disparities are relatively well-studied among adults with epilepsy, but substantially less so among children. This study examines whether children with epilepsy 1) have lower SES than or 2) utilize healthcare resources differently from their peers, and 3) if SES moderates healthcare resource utilization. Methods Data from the 2016-2019 National Survey of Children’s Heath (NSCH) were used to identify children with active “epilepsy or seizure disorder”. Children with versus without epilepsy were compared. SES and healthcare utilization variables were modeled with logistic and Poisson regressions. Significance was assessed at the alpha=0.05 level. Results This analysis included 131,326 children; 835 were diagnosed with active epilepsy. The estimated population prevalence of epilepsy was 0.6%. A higher proportion of those with epilepsy were Black, non-Hispanic. Children with epilepsy were more likely to visit an ED (aOR=5.4), have seen a healthcare professional for medical care (aOR: 2.7), have ≥1 preventative checkup (aOR: 2.3), and receive medical care from a specialist (aOR: 10.3). Children from higher-income households were less likely to have epilepsy (aOR: 0.7). SES moderated the relationship between epilepsy status and ED visits. Still, 7.7% of children with epilepsy needed healthcare but did not receive it, the most common barriers being: ineligibility for services (aOR: 3.2), problems getting an appointment (aOR: 3.9), and transportation issues (aOR: 4.7). Conclusions Children with epilepsy were more likely than their peers to live in lower income households, visit EDs, and see healthcare professionals. Despite increased needs, children with epilepsy had 2.6 times the odds of not receiving needed healthcare. SES moderated the relationship between epilepsy status and healthcare resource utilization. Most common barriers to healthcare were: service eligibility, appointment scheduling, and transport. Barrier-specific policy interventions may improve medical care access for children with epilepsy.