Utilization of epilepsy care among Women Veterans: A population-based study

Erin Sullivan-Baca; Sara A Lorkiewicz; Rizwana Rehman; Anne C Van Cott; Alan R Towne; Zulfi Haneef

doi:10.1016/j.eplepsyres.2023.107130

Utilization of epilepsy care among Women Veterans: A population-based study

Epilepsy Res. 2023 May:192:107130. doi: 10.1016/j.eplepsyres.2023.107130. Epub 2023 Mar 22.

Authors

Erin Sullivan-Baca¹, Sara A Lorkiewicz², Rizwana Rehman³, Anne C Van Cott⁴, Alan R Towne⁵, Zulfi Haneef⁶

Affiliations

¹ Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
² Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA.
³ Epilepsy Centers of Excellence, Veteran's Health Administration, USA; Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, USA.
⁴ Neurology Division, VA Pittsburgh Healthcare System, 4100 Allequippa St., Pittsburgh, PA 15240, USA; Department of Neurology, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
⁵ Epilepsy Centers of Excellence, Veteran's Health Administration, USA; Epilepsy Centers of Excellence, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd., Richmond, VA 23249, USA; Department of Neurology, Virginia Commonwealth University School of Medicine, 1201 East Marshall Street, Richmond, VA 23298, USA.
⁶ Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Epilepsy Centers of Excellence, Veteran's Health Administration, USA. Electronic address: Zulfi.haneef@bcm.edu.

PMID: 37004372
DOI: 10.1016/j.eplepsyres.2023.107130

Abstract

Objective: Higher healthcare utilization in epilepsy correlates with better clinical and quality of life outcomes. Women Veterans with epilepsy (WVE) have unique characteristics that may affect access and utilization of care. This study investigates epilepsy care in WVE, with respect to utilization of outpatient, inpatient, and emergency room care.

Methods: Data were collected from 58,525 Veterans with epilepsy using the Veterans Health Administration (VHA) Corporate Data Warehouse administrative data. Overall, 8.5% of the sample were women (n = 4983). Neurology visits, comprehensive epilepsy care, neuroimaging, ASM prescription and hospital and emergency care were analyzed, and comparisons were made with men Veterans with epilepsy to identify gender differences.

Results: Compared to men, a greater proportion of WVE utilized services including neurology (73.8% vs. 62.0%), comprehensive epilepsy care (16.1% vs. 11.7%), epilepsy monitoring unit evaluation (EMU; 6.1% vs. 2.9%), neuroimaging (CT: 39.1% vs. 36.6%; MRI: 43.7% vs. 32.5%), and electroencephalograms: (EEG: 36.5% vs. 29.1%). WVE also evidenced higher percentages of seizure-related emergency room care usage vs. men (15.2 vs. 12.6) and hospitalizations (12.3 vs. 10.0) and were prescribed a greater number of ASMs (average:2.3 vs. 1.9). Valproate was prescribed to 17.6% of WVE, despite potential teratogenic concerns.

Significance: WVE have greater utilization of epilepsy care within the VHA system compared to men, which could lead to better epilepsy management and quality of life. However, higher rates of emergency care, hospitalizations, and concurrent ASMs among WVE highlight the clinical complexity and raise concern for potentially comorbid conditions including psychogenic non-epileptic seizures.

Keywords: Healthcare utilization; Sex differences; Veterans; Women.

MeSH terms

Epilepsy* / drug therapy
Epilepsy* / epidemiology
Female
Hospitalization
Humans
Male
Quality of Life
Seizures / drug therapy
Seizures / epidemiology
Veterans* / psychology