Advertisement

Social determinants of health in epilepsy

      Highlights

      • A theoretical framework is proposed to study social factors in epilepsy.
      • Epilepsy outcomes vary by social category, context, and mediating conditions.
      • Disparities in epilepsy result from social differentials among individuals/groups.
      • Material, psychosocial, and care factors mediate disparities in epilepsy.
      • Theory-based research is the first step toward eliminating disparities in epilepsy.

      Abstract

      Social factors have been identified as key drivers of epilepsy care, outcomes, and disparities, but there is a limited understanding of what these factors are and how they translate into disparities. This targeted review provides an overview of the social determinants of health framework and applies this perspective to the literature about social and psychosocial factors in epilepsy; a social determinants of health — epilepsy model is proposed. The key social determinants of health in epilepsy include socioeconomic status, race/ethnicity, age, and gender. For example, low socioeconomic status and minority status have been associated with a higher risk of epilepsy, more hospitalizations and emergency room visits (versus neurology services), antiepileptic drug nonadherence, and a lower rate of epilepsy surgery. Such differences in care/treatment and outcomes translate into health disparities, many of which are considered unjust (inequitable) and modifiable through social action. Other social determinants of health include structural and sociocultural contextual conditions (e.g., health economy, policy, and social stigma/discrimination) and mediating mechanisms including material (e.g., housing), behavioral/biological (e.g., adherence), psychosocial (e.g., perceived stigma), and health system (e.g., access) factors. There are complex relationships among social determinants of health in epilepsy, which remain poorly understood and hamper efforts to address and eliminate disparities in epilepsy care and outcomes. Further empirical work grounded in sound theory and robust methodologies is needed to identify points of intervention and design effective and socially acceptable solutions to any pervasive disparities in epilepsy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Epilepsy & Behavior
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Institute of Medicine (U.S.)
        Committee on the Public Health Dimensions of the Epilepsies, England MJ. Epilepsy across the spectrum: promoting health and understanding.
        National Academies Press, Washington, D.C.2012
        • Wiebe S.
        • Camfield P.
        • Jette N.
        • Burneo J.G.
        Epidemiology of epilepsy: prevalence, impact, comorbidity and disparities.
        Can J Neurol Sci. 2009; 36: S7-S16
        • Burneo J.G.
        • Jette N.
        • Theodore W.
        • Begley C.
        • Parko K.
        • Thurman D.J.
        • et al.
        Disparities in epilepsy: report of a systematic review by the North American Commission of the International League Against Epilepsy.
        Epilepsia. 2009; 50: 2285-2295
        • Jacoby A.
        • Baker G.A.
        • Crossley J.
        • Schachter S.
        Tools for assessing quality of life in epilepsy patients.
        Expert Rev Neurother. 2013; 13: 1355-1369
        • Elliott J.O.
        • Lu B.
        • Shneker B.F.
        • Moore J.L.
        • McAuley J.W.
        The impact of ‘social determinants of health’ on epilepsy prevalence and reported medication use.
        Epilepsy Res. 2009; 84: 135-145
        • Marmot M.
        Fair society, health lives: ‘The Marmot Review’. The Marmot Review.
        (Available at) ([Accessed 26 November 2013])
        • Sadana R.
        • Blas E.
        What can public health programs do to improve health equity?.
        Public Health Rep. 2013; 128: 12-20
        • Szaflarski M.
        • Vaughn L.
        Deconstructing and addressing health disparities to build health equity.
        in: Murray M. Critical health psychology. 2nd ed. Palgrave Macmillan, 2014 ([forthcoming])
        • Adler N.E.
        • Stewart J.
        Health disparities across the lifespan: meaning, methods, and mechanisms.
        Ann N Y Acad Sci. 2010; 1186: 5-23
        • Department of Health and Social Security
        Inequalities in health: report of a research working group.
        DHSS, London, UK1980
        • Marmot M.G.
        • Rose G.
        • Shipley M.
        • Hamilton P.J.
        Employment grade and coronary heart disease in British civil servants.
        J Epidemiol Community Health. 1978; 32: 244-249
        • Marmot M.G.
        • Shipley M.J.
        • Rose G.
        Inequalities in death-specific explanations of a general pattern?.
        Lancet. 1984; 1: 1003-1006
        • Whitehead M.
        • Dahlgren G.
        What can be done about inequalities in health?.
        Lancet. 1991; 338: 1059-1063
        • Cockerham W.C.
        Social causes of health and disease.
        2nd ed. Polity, Malden, MA2013
        • Link B.
        • Phelan J.
        Social conditions as fundamental causes of health inequalities.
        in: Bird C.E. Condrad P. Fremont A.M. Timmermans S. Handbook of medical sociology. 6th ed. Vanderbilt University Press, Nashville, TN2010: 3-17
        • Solar O.
        • Irwin A.
        A conceptual framework for action on the social determinants of health.
        in: Discussion paper series on social determinants of health. 2. World Health Organization, Geneva, Switzerland2010 ([Available at http://whqlibdoc.who.int/publications/2010/9789241500852_eng.pdf. Accessed 2 December 2013])
        • Kawachi I.
        Social capital and health.
        in: Bird C.E. Condrad P. Fremont A.M. Timmermans S. Handbook of medical sociology. 6th ed. Vanderbilt University Press, Nashville, TN2010: 18-32
        • Ross C.E.
        • Mirowsky J.
        Why education is key to sicoeconomic differentials in health.
        in: Bird C.E. Condrad P. Fremont A.M. Timmermans S. Handbook of medical sociology. 6th ed. Vanderbilt University Press, Nashville2010: 33-51
        • Wiebe S.
        • Bellhouse D.R.
        • Fallahay C.
        • Eliasziw M.
        Burden of epilepsy: the Ontario Health Survey.
        Can J Neurol Sci. 1999; 26: 263-270
        • Bautista R.E.D.
        • Bautista M.A.D.
        Health literacy and the outcomes of care among individuals with epilepsy.
        Soc Behav Epilepsy. 2011; : 73-91
        • Szaflarski M.
        • Szaflarski J.P.
        • Privitera M.D.
        • Ficker D.M.
        • Horner R.D.
        Racial/ethnic disparities in the treatment of epilepsy: what do we know? What do we need to know?.
        Epilepsy Behav. 2006; 9: 243-264
        • Theodore W.H.
        • Spencer S.S.
        • Wiebe S.
        • Langfitt J.T.
        • Ali A.
        • Shafer P.O.
        • et al.
        Epilepsy in North America: a report prepared under the auspices of the global campaign against epilepsy, the International Bureau for Epilepsy, the International League Against Epilepsy, and the World Health Organization.
        Epilepsia. 2006; 47: 1700-1722
        • Curry Jr., W.T.
        • Carter B.S.
        • Barker II, F.G.
        Racial, ethnic, and socioeconomic disparities in patient outcomes after craniotomy for tumor in adult patients in the United States, 1988–2004.
        Neurosurgery. 2010; 66 ([discussion 437–428]): 427-437
        • Kharkar S.
        • Pillai J.
        • Rochestie D.
        • Haneef Z.
        Socio-demographic influences on epilepsy outcomes in an inner-city population.
        Seizure. 2014; 23: 290-294
        • Pisu M.
        • Richman J.S.
        • Martin R.C.
        • Kim Y.
        • Kratt P.
        • Clements K.
        • et al.
        Diagnostic tests and neurology care for Medicare beneficiaries with seizures: differences across racial groups.
        Med Care. 2012; 50: 730-736
        • McNelis A.M.
        • Buelow J.
        • Myers J.
        • Johnson E.A.
        Concerns and needs of children with epilepsy and their parents.
        Clin Nurse Spec. 2007; 21: 195-202
        • McNelis A.M.
        • Dunn D.W.
        • Johnson C.S.
        • Austin J.K.
        • Perkins S.M.
        Academic performance in children with new-onset seizures and asthma: a prospective study.
        Epilepsy Behav. 2007; 10: 311-318
        • Tse E.
        • Hamiwka L.
        • Sherman E.M.
        • Wirrell E.
        Social skills problems in children with epilepsy: prevalence, nature and predictors.
        Epilepsy Behav. 2007; 11: 499-505
        • McClelland III, S.
        • Curran C.C.
        • Davey C.S.
        • Okuyemi K.S.
        Intractable pediatric temporal lobe epilepsy in the United States: examination of race, age, sex, and insurance status as factors predicting receipt of resective treatment.
        J Neurosurg. 2007; 107: 469-473
        • Thompson A.W.
        • Kobau R.
        • Park R.
        • Grant D.
        Epilepsy care and mental health care for people with epilepsy: California Health Interview Survey, 2005.
        Prev Chronic Dis. 2012; 9: E60
        • Sherman E.M.
        • Griffiths S.Y.
        • Akdag S.
        • Connolly M.B.
        • Slick D.J.
        • Wiebe S.
        Sociodemographic correlates of health-related quality of life in pediatric epilepsy.
        Epilepsy Behav. 2008; 12: 96-101
        • Begley C.E.
        • Famulari M.
        • Annegers J.F.
        • et al.
        The cost of epilepsy in the United States: an estimate from population-based clinical and survey data.
        Epilepsia. 2000; 41: 342-351
        • Hatzenbuehler M.L.
        • Phelan J.C.
        • Link B.G.
        Stigma as a fundamental cause of population health inequalities.
        Am J Public Health. 2013; 103: 813-821
        • Carter-Pokras O.
        • Baquet C.
        What is a “health disparity”?.
        Public Health Rep. 2002; 117: 426-434
        • Begley C.E.
        • Famulari M.
        • Annegers J.F.
        • Lairson D.R.
        • Reynolds T.F.
        • Coan S.
        • et al.
        Socioeconomic status, health care use, and outcomes: persistence of disparities over time.
        Epilepsia. 2011; 52: 957-964
      1. Eyal N.M. Hurst S.A. Norheim O.F. Wikler D. Inequalities in health: concepts, measures, and ethics. Oxford University Press, Oxford2013
        • Burneo J.G.
        • Black L.
        • Knowlton R.C.
        • Faught E.
        • Morawetz R.
        • Kuzniecky R.I.
        Racial disparities in the use of surgical treatment for intractable temporal lobe epilepsy.
        Neurology. 2005; 64: 50-54
        • Englot D.J.
        • Ouyang D.
        • Garcia P.A.
        • Barbaro N.M.
        • Chang E.F.
        Epilepsy surgery trends in the United States, 1990–2008.
        Neurology. 2012; 78: 1200-1206
        • Ott D.
        • Siddarth P.
        • Gurbani S.
        • Koh S.
        • Tournay A.
        • Shields W.D.
        • et al.
        Behavioral disorders in pediatric epilepsy: unmet psychiatric need.
        Epilepsia. 2003; 44: 591-597
        • Hesdorffer D.C.
        • Tian H.
        • Anand K.
        • Hauser W.A.
        • Ludvigsson P.
        • Olafsson E.
        • et al.
        Socioeconomic status is a risk factor for epilepsy in Icelandic adults but not in children.
        Epilepsia. 2005; 46: 1297-1303
        • Briesacher B.A.
        • Andrade S.E.
        • Fouayzi H.
        • Chan K.A.
        Comparison of drug adherence rates among patients with seven different medical conditions.
        Pharmacotherapy. 2008; 28: 437-443
        • Faught E.
        • Duh M.S.
        • Weiner J.R.
        • Guerin A.
        • Cunnington M.C.
        Nonadherence to antiepileptic drugs and increased mortality: findings from the RANSOM Study.
        Neurology. 2008; 71: 1572-1578
        • Elliott J.O.
        • Charyton C.
        • Lu B.
        • Moore J.L.
        Serious psychological distress and health outcomes for persons with epilepsy in poverty.
        Seizure. 2009; 18: 332-338
        • Elliott J.O.
        • Lu B.
        • Moore J.L.
        • McAuley J.W.
        • Long L.
        Exercise, diet, health behaviors, and risk factors among persons with epilepsy based on the California Health Interview Survey, 2005.
        Epilepsy Behav. 2008; 13: 307-315
        • Sherman E.M.
        Maximizing quality of life in people living with epilepsy.
        Can J Neurol Sci. 2009; 36: S17-S24
        • Long L.
        • Reeves A.L.
        • Moore J.L.
        • Roach J.
        • Pickering C.T.
        An assessment of epilepsy patients' knowledge of their disorder.
        Epilepsia. 2000; 41: 727-731
        • Lu C.
        • Wirrell E.
        • Blackman M.
        Where do families of children with epilepsy obtain their information?.
        J Child Neurol. 2005; 20: 905-910
        • Swarztrauber K.
        • Dewar S.
        • Engel Jr., J.
        Patient attitudes about treatments for intractable epilepsy.
        Epilepsy Behav. 2003; 4: 19-25
        • Baker G.A.
        • Hargis E.
        • Hsih M.M.
        • Mounfield H.
        • Arzimanoglou A.
        • Glauser T.
        • et al.
        Perceived impact of epilepsy in teenagers and young adults: an international survey.
        Epilepsy Behav. 2008; 12: 395-401
        • Begley C.E.
        • Shegog R.
        • Iyagba B.
        • Chen V.
        • Talluri K.
        • Dubinsky S.
        • et al.
        Socioeconomic status and self-management in epilepsy: comparison of diverse clinical populations in Houston, Texas.
        Epilepsy Behav. 2010; 19: 232-238
        • Hauptman J.S.
        • Dadour A.
        • Oh T.
        • Baca C.B.
        • Vickrey B.G.
        • Vassar S.
        • et al.
        Time to pediatric epilepsy surgery is longer and developmental outcomes lower for government compared with private insurance.
        Neurosurgery. 2013; 73: 152-157
        • Begley C.E.
        • Basu R.
        • Reynolds T.
        • Lairson D.R.
        • Dubinsky S.
        • Newmark M.
        • et al.
        Sociodemographic disparities in epilepsy care: results from the Houston/New York City health care use and outcomes study.
        Epilepsia. 2009; 50: 1040-1050
        • Avetisyan R.
        • Cabral H.
        • Montouris G.
        • Jarrett K.
        • Shapiro G.D.
        • Berlowitz D.R.
        • et al.
        Evaluating racial/ethnic variations in outpatient epilepsy care.
        Epilepsy Behav. 2013; 27: 95-101
        • Thurman D.J.
        • Beghi E.
        • Begley C.E.
        • Berg A.T.
        • Buchhalter J.R.
        • Ding D.
        • et al.
        Standards for epidemiologic studies and surveillance of epilepsy.
        Epilepsia. 2011; 52: 2-26
        • Hesdorffer D.C.
        • Begley C.E.
        Surveillance of epilepsy and prevention of epilepsy and its sequelae: lessons from the Institute of Medicine report.
        Curr Opin Neurol. 2013; 26: 168-173
        • IOM (Institute of Medicine)
        Capturing social and behavioral domains in electronic health records: phase 1.
        The National Academies Press, Washington, DC2014