Social determinants of health and healthcare utilization in Veterans with post-traumatic epilepsy

Abstract: OBJECTIVE: Patients with post-traumatic epilepsy (PTE) are at an increased risk of adverse outcomes, and utilization of specialty care is important to manage symptoms. We examined the relationship between social determinants of health (SDoH) and healthcare utilization in Veterans with PTE (VWPTE). METHODS: Data were collected from the Veterans Affairs (VA) Corporate Data Warehouse administrative data. SDoH data were derived from ICD-10-CM codes, and area deprivation index (ADI) was based on patient zip code. Utilization measures included neurology encounters, comprehensive epilepsy care, neuroimaging, and seizure-related emergency care. Logistic and Poisson regressions were used to model the effect of demographics, epilepsy characteristics, patient comorbidities, and SDoH on utilization measures. RESULTS: There were 6732 VWPTE who met inclusion criteria. Increased ADI quartile (i.e. higher area deprivation) relative to the first quartile was strongly predictive of decreased utilization, including fewer VA general neurology clinic visits (second quartile IRR=0.926, 95% CI 0.866, 0.990, p=0.024; third quartile IRR=0.866, 95% CI 0.812, 0.925, p<0.001; fourth quartile IRR=0.745, 95% CI 0.690, 0.804, p<0.001), epilepsy specialty care (third quartile OR=0.594, 95% CI 0.485, 0.729, p<0.001; fourth quartile OR=0.306, 95% CI 0.235, 0.395, p<0.001), MRI studies (fourth quartile OR=0.761, 95% CI 0.610, 0.946, p=0.014) and lower EEG usage (fourth quartile OR=0.665, 95% CI 0.532, 0.830, p<0.001). Additional SDoH were inconsistently correlated to utilization. CONCLUSION: Higher area deprivation predicted lower healthcare utilization in VWPTE across several metrics of specialized epilepsy care and neuroimaging, though individual SDoH based on ICD-10-CM codes were inconsistently correlated to utilization.