Highlights
- •The ADI is an effective tool for assessing disadvantage of pediatric epilepsy.
- •Disadvantaged conferred risk for diminished HRQoL and familial factors.
- •Propose ecological model to examine determinants of HRQoL.
- •Need for whole-child approach to epilepsy management.
Abstract
Introduction
While several demographic and epilepsy-specific characteristics are associated with
diminished HRQoL in children and adolescents with epilepsy, prior investigations have
failed to incorporate and address the influence of broader social contextual factors
on functional outcomes. To address this gap, the purpose of the current study was
to investigate the role of neighborhood disadvantage on HRQoL, including the extent
to which familial and seizure-specific risk factors are impacted.
Methods
Data included parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE)
questionnaire for 135 children and adolescents with epilepsy, and the Area Deprivation
Index (ADI) to measure neighborhood disadvantage. Bivariate correlations were conducted
to identify significant associations with neighborhood disadvantage, followed by a
three-stage hierarchical multiple regression to predict HRQoL. Follow-up binary logistic
regressions were used to determine the risk conferred by neighborhood disadvantage
on sociodemographic, seizure-specific, and HRQoL factors.
Results
Moderate associations between neighborhood disadvantage and familial factors, including
parental psychiatric history and Medicaid insurance, were identified, while disadvantage
and greater seizure frequency were marginally associated. Neighborhood disadvantage
independently predicted HRQoL, and was the sole significant predictor of HRQoL when
familial factors were incorporated. Children with epilepsy living in disadvantaged
areas were four times more likely to have diminished HRQoL, five times more likely
to live with a parent with a significant psychiatric history, and four times more
likely to reside with a family receiving Medicaid insurance.
Conclusions
These results highlight the importance of identifying high-risk groups, as the cumulative
burden of social context, familial factors, and seizure-specific characteristics contribute
to lower HRQoL in pediatric epilepsy which disproportionately affects patients from
lower-resourced backgrounds. Potentially modifiable factors such as parental psychiatric
status exist within the child’s environment, emphasizing the importance of a whole-child
approach to patient care. Further exploration of disadvantage in this population is
needed to better understand these relationships over time.
Keywords
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Article info
Publication history
Published online: March 27, 2023
Accepted:
March 5,
2023
Received in revised form:
March 4,
2023
Received:
December 12,
2022
Identification
Copyright
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