Racial, Ethnic Disparities Exist in Epilepsy Incidence in Medicare Beneficiaries

Epilepsy incidence was found to be higher in the period between 2016 and 2019 compared with previous years among older adults receiving Medicare, according to study findings published in Neurology journal.

Previous incident studies have been limited in their ability to assess epilepsy incidence by age, sex, and race and ethnicity because of reliance on data from small longitudinal studies. This has resulted in inconsistent estimates.

Researchers analyzed recent trends in epilepsy incidence among Medicare beneficiaries in an effort to inform future health care delivery and prevention strategies.

The researchers collected data from Medicare beneficiaries between 2016 and 2019. Incident epilepsy was identified from the Centers for Medicare & Medicaid Services (CMS) database and defined as least 1 inpatient claim or 2 outpatient nondrug claims occurring 1 day apart within 2 years.

A total of 4,999,996 beneficiaries (median age, 77.2; women, 55.03%; non-Hispanic White, 77.3%) were included in the analysis. Overall, 20,545 cases of epilepsy were observed among 19,631 participants.

Based on study findings, the researchers made the following observations:

• Epilepsy incidence increased with age, peaking between ages 85 and 89 (incidence rate [IR] per 100,000, 550; 99% CI, 523-578).
• Men had a slightly higher risk for epilepsy compared with women, after controlling for age differences (IR, 396 [99% CI, 385-407] vs 376 [99% CI, 366-385]; age-adjusted IRR, 1.06; 99% CI, 1.02-1.09; P <.001).
• Black and Hispanic beneficiaries had a higher risk, while Asian/Pacific Islander (API) had a lower risk, for epilepsy incidence compared with non-Hispanic beneficiaries. (Black: IR, 678 [653-702]; IRR, 1.87 [1.79-1.95]; Hispanic: IR, 405 [384-426]; IRR, 1.12 [1.05-1.18]; API: IR, 272 [239-305]; IRR, 0.75 [0.66-0.84]; all P <.001; non-Hispanic White: IR, 354 [299-408]; IRR, 0.97 [0.82-1.13]; P =.670).
• Overall, incidence of epilepsy varies by race and ethnicity, sex, and age, for some subgroups.

Limitations of the analysis included that participants were enrolled in the “traditional” vs “managed care” Medicare programs, which may not have been representative of the entire population; data were based on administrative records; and the lack of inclusion of all races to the same percentage (Black and Hispanic beneficiaries were oversampled).

“Efforts to provide care and services that improve quality of life for older adults living with epilepsy should consider differences by multiple social characteristics simultaneously: age, sex, and race/ethnicity,” the researchers concluded.