Determinants of Health for People with Epilepsy

A national cross-sectional survey, National Health Interview Survey (NHIS), was used to gain a better understanding of the role of structural and intermediary determinants on health status and wellbeing among people with epilepsy (PWE). This study took a holistic approach that was grounded using the World Health Organization (WHO) conceptual framework for action on social determinants of health. Further analyses were conducted using the same survey to understand the role of occupation as a determinant of health for PWE. Lastly, hospital billing data was used to calculate rates of seizures at the zip code level; then calculated the association between point source pollution and community level factors with seizure rates. When considering structural and intermediary determinants of health, our model demonstrated the complexity and depth of the impact of epilepsy on an individual’s life. The health and wellbeing of PWE is adversely affected across nearly all measures of the structural determinants of health. The analysis revealed notable disparities in education, marital status, reasons for delaying healthcare, self-reported health status, and limitations in activities of daily living. The results of the multivariable models revealed that 1) inequities may persist after someone has well controlled or a history of epilepsy 2) PWE experience inequities across many SDOH indicators and 3) the largest disparities were observed in the group that experienced the most seizures in the past year. People with epilepsy are impacted by multiple structural determinants of health which, through a variety of pathways, affect multiple intermediary determinants and affect disparities we see in access to appropriate healthcare needs for PWE and health inequities. This suggests a potential for compounding and synergistic impacts that may persist throughout the lifetime of PWE. People with epilepsy, particularly those with active epilepsy, were far less likely to participate in the labor force. When they did have employment, the jobs were more likely to be low paying, with limited benefits, in non-management positions, and involve harassment on the job. Models showed that even when controlling for age, race, ethnicity, sex, and education, the odds of labor force participation was substantially lower among all PWE. In addition, PWE were less likely to report that their current job is their longest held job which may be an indicator of occupational instability. Lastly, the number of toxic release inventory sites in a zip code was associated with increased hospitalization of seizures. When stratified by region, the association was stronger in zip codes outside of the Chicagoland metropolitan statistical area. When the polluting sites were categorized based on type of pollutants released, the models revealed further differences in strength of association. For zip codes within Chicagoland, seizure rates were significantly associated with pesticide releasing sites and solvent releasing sites, community level factors related to employment status also had a significant association. For zip codes outside of Chicagoland, seizure rates were significantly associated with benzene, toluene, ethylbenzene and xylene, lead, and non-lead metal releasing sites and solvent releasing sites. In these zip codes community level factors that also were significantly associated with seizure rates included factors related to socioeconomic position, employment status, and immigration status. This suggests that there may be different social drivers impacting the health of PWE in areas near Chicagoland compared to those outside. The findings from this research provide significant considerations for preventing and limiting the harms of secondary adverse outcomes, supporting PWE. Supporting the idea that interventions need to be broad in scope, addressing multiple facets of life for PWE. Most importantly, this demonstrates that medical treatment alone will not reverse all of the adverse effects of epilepsy, as shown by the fact that persons with a history of and controlled epilepsy continue to experience adverse impacts on their health and wellbeing.