Researchers identified wide-ranging disparities in the patterns of antiseizure mediation generation used across racial and ethnic groups.

“Treatment-level decisions, such as patterns in antiseizure medication use, provide an interesting and compelling health equity indicator,” Wyatt P. Bensken, PhD, says. “There has been incredibly limited work to understand potential disparities and inequities in pharmacological treatment in neurology and certainly in epilepsy. To advance neurology health equity efforts, we have to understand all potential avenues of disparities and inequities.”

For a study published in Neurology: Clinical Practice, Dr. Bensken, Siran M. Koroukian, PhD, and colleagues aimed “to understand if there was meaningful variation in antiseizure medication use across racial and ethnic groups among patients with epilepsy on Medicaid,” Dr. Koroukian says. “By using Medicaid claims data, we were able to include over 78,000 unique patients in our study. This population-level analysis provides compelling evidence of trends that exist across states and care settings.”

Drs. Bensken, Koroukian, and colleagues determined the type and number of antiseizure medications used by adults with epilepsy aged 18-64 in 15 states over a 5-year period, as well as adherence. They obtained data on demographics, inpatient claims, other services such as outpatient provider claims, and prescriptions obtained while the patient was enrolled in Medicaid. The study team used multi-level logistic regression models to analyze the association between newer generation antiseizure medications and adherence. They also assessed racial/ethnic differences in antiseizure medication use in models that accounted for demographics, utilization, year, and comorbidities.

Disparities in Use of Old Vs. New Antiseizure Medications

The study population included 78,534 adults with epilepsy (17,729 Black; 9,376 Hispanic). About a quarter of patients (25.6%) were being treated with older antiseizure medications.

The researchers observed several findings related to the type of antiseizure medication, adherence, and patient characteristics. Use of only a second-generation antiseizure medication was associated with improved adherence (adjusted OR [aOR]: 1.17; 95% CI, 1.11-1.23). The odds of being on a newer antiseizure medication was higher among individuals treated by a neurologist (aOR, 3.26; 95% CI, 3.13-3.41) or who were recently diagnosed (aOR, 1.29; 95% CI, 1.16-1.42). In addition, compared with White patients, the odds of treatment with newer antiseizure medications was lower among Black (aOR, 0.71; 95% CI, 0.68-0.75), Hispanic (aOR, 0.93: 95% CI, 0.88-0.99), and Native Hawaiian and other Pacific Island individuals (aOR, 0.77; 95% CI, 0.67-0.88).

“We observed greater adherence among those on newer antiseizure medications, and we also saw racial and ethnic disparities in generation of antiseizure medication,” Dr. Bensken notes. “Disparities in adherence persisted even after accounting for generation of antiseizure medication.”

Patterns in the generation of antiseizure mediation used across racial and ethnic groups “were varied, but consistent,” according to Dr. Koroukian (Figure). “We observed a higher percentage of non-White patients on first- and second-generation antiseizure medications. Simply, racial and ethnic minoritized populations have a higher frequency of older anti-seizure medication use.”

Addressing Epilepsy-Related Healthcare Inequities

The findings “underscore the multifactorial disparities in treatment and medication adherence among patients with epilepsy,” according to Dr. Bensken.

“While it is well-documented that there are racial and ethnic disparities in adherence, our study furthered the evidence of these wide-ranging disparities,” Dr. Koroukian adds.

Dr. Koroukian also described the implications for practicing clinicians.

“We hope our study will raise awareness of these disparities and motivate greater examination of potential biases that influence patient care,” she says. “Research has shown that a non-White patient may be less likely to report side effects, and they are likely to be taken less seriously when reported. With the racial disparity in the neurology workforce, being aware of these dynamics that enter every element of patient care should be a call to action to more thoughtfully and carefully consider how biases may impact healthcare.”

 According to Dr. Bensken, the findings “are just the start” to begin understanding, and addressing, epilepsy-related healthcare inequities.

“Further research is needed to uncover the specific factors, such as implicit bias and structural racism, that are creating these disparities,” he says. “Importantly, we hope our findings will motivate individual practices and health systems to examine these patterns in their patients.”