Geographic Disparities in People with Epilepsy: Differences in Self-Efficacy and Quality of Life

Background and Purpose: Approximately 19% of the U.S population live in rural locales, which are disproportionally afflicted by health disparities. While people with epilepsy (PWE) living in rural areas may have difficulties receiving appropriate care, little is known about differences in PWE due to geography. This study evaluated whether clinical and demographic characteristics among PWE differed by geographic region to better characterize potential differences in care and outcomes faced by rural people with epilepsy (RPWE).Methods: This cross-sectional baseline data analysis from an epilepsy self-management clinical trial examined quality of life, functional status, self-management, self-efficacy, depression, and social support. The independent variable of interest was geography of residence (categorized using Rural-Urban Continuum Codes (RUCC): metro areas [RUCC 1-3], adjacent to metro areas [RUCC 4, 6, 8], and rural [RUCC 5, 7, 9]). Amongst covariates were other social determinants of health (SDOH): income and education. Multivariable linear regression models were conducted, including the three SDOH and other covariates.Results: Adjusting for likely confounders, geography was independently associated with three outcomes: the epilepsy self-efficacy scale (ESES) scores, quality of life in epilepsy (QOLIE-31) total scores, and QOLIE-31 cognition sub scores. RPWE had lower ESES scores (p=0.045), lower QOLIE-31 total scores (p=0.025), and lower QOLIE-31-cognition sub scores (p=0.043) compared to urban PWE. On average, RPWE had an 11-point lower QOLIE-31 total score.Conclusions: RPWE have lower self-efficacy, worse quality of life, and perceived cognitive functioning compared to urban PWE. These geographic disparities may reflect disparities in access to epilepsy care that are associated with worse outcomes among RPWE.