RT Journal Article
SR Electronic
T1 Racial and Ethnic Differences in Antiseizure Medications Among People With Epilepsy on Medicaid
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP e200101
DO 10.1212/CPJ.0000000000200101
VO 13
IS 1
A1 Wyatt P. Bensken
A1 Guadalupe Fernandez Baca Vaca
A1 Philip M. Alberti
A1 Omar I. Khan
A1 Timothy H. Ciesielski
A1 Barbara C. Jobst
A1 Scott M. Williams
A1 Kurt C. Stange
A1 Martha Sajatovic
A1 Siran M. Koroukian
YR 2023
UL http://cp.neurology.org/content/13/1/e200101.abstract
AB Background and Objectives Being on a newer, second-, and third-generation antiseizure medication (ASM) may represent an important marker of quality of care for people with epilepsy. We sought to examine whether there were racial/ethnic differences in their use.Methods Using Medicaid claims data, we identified the type and number of ASMs, as well as the adherence, for people with epilepsy over a 5-year period (2010–2014). We used multilevel logistic regression models to examine the association between newer-generation ASMs and adherence. We then examined whether there were racial/ethnic differences in ASM use in models adjusted for demographics, utilization, year, and comorbidities.Results Among 78,534 adults with epilepsy, 17,729 were Black, and 9,376 were Hispanic. Overall, 25.6% were on older ASMs, and being solely on second-generation ASMs during the study period was associated with better adherence (adjusted odds ratio: 1.17, 95% confidence interval [CI]: 1.11–1.23). Those who saw a neurologist (3.26, 95% CI: 3.13–3.41) or who were newly diagnosed (1.29, 95% CI: 1.16–1.42) had higher odds of being on newer ASMs. Importantly, Black (0.71, 95% CI: 0.68–0.75), Hispanic (0.93, 95% CI: 0.88–0.99), and Native Hawaiian and Other Pacific Island individuals (0.77, 95% CI: 0.67–0.88) had lower odds of being on newer ASMs when compared with White individuals.Discussion Generally, racial and ethnic minoritized people with epilepsy have lower odds of being on newer-generation ASMs. Greater adherence by people who were only on newer ASMs, their greater use among people seeing a neurologist, and the opportunity of a new diagnosis point to actionable leverage points for reducing inequities in epilepsy care.