University of Texas, School of Public Health, Division of Management, Policy, and Community Health, Houston, Texas, USA.
Epilepsia. 2011 May;52(5):957-64. doi: 10.1111/j.1528-1167.2010.02968.x. Epub 2011 Feb 14.
To determine the persistence of disparities in health care use and outcomes in socioeconomically diverse populations of epilepsy patients.
We followed patients for a year at one clinic in Houston and two in New York City that serve predominantly low-income, minority, Medicaid-insured, or uninsured patients, and a fourth clinic in Houston that serves a more balanced racial/ethnic and higher socioeconomic status (SES) population. We interviewed the patients several times regarding health care use, seizures, side effects, and outcomes, and examined differences between the patients at the three low-SES clinics and the patients at the high-SES clinic.
After controlling for patients' age, gender, race/ethnicity, marital status, seizures, and side effects we found that low SES patients had consistently higher use of the hospital emergency room and more visits to a general practitioner. Hospitalizations were also consistently higher but the differences were not significant in most periods. Neurologist visits were relatively similar. Patients at the low SES sites also had a greater likelihood of having uncontrolled seizures, drug-related side effects, to be stigmatized, and have a lower overall quality of life throughout the study period.
These findings suggest the persistence of SES-related disparities in health care use and outcomes among patients with epilepsy who are receiving regular care.
确定在社会经济多样化的癫痫患者群体中，医疗保健利用和结果的差异是否持续存在。
我们在休斯顿的一家诊所、纽约的两家诊所（主要为低收入、少数族裔、医疗补助保险或无保险患者服务）和休斯顿的第四家诊所对患者进行了为期一年的随访，这些诊所服务的患者种族/民族和社会经济地位（SES）更加均衡。我们多次采访患者，了解他们的医疗保健利用、癫痫发作、副作用和结果，并比较了三个低 SES 诊所的患者和高 SES 诊所的患者之间的差异。
在控制患者的年龄、性别、种族/民族、婚姻状况、癫痫发作和副作用后，我们发现低 SES 患者急诊室就诊和普通医生就诊的次数明显更高。住院治疗也明显更高，但在大多数时期差异并不显著。神经内科就诊次数相对相似。在整个研究期间，低 SES 患者癫痫发作控制不良、药物相关副作用、被污名化和整体生活质量较低的可能性更大。
这些发现表明，在接受常规治疗的癫痫患者中，社会经济地位相关的医疗保健利用和结果差异仍然存在。
