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Socioeconomic outcome and access to care in adults with epilepsy in Sweden: A nationwide cohort study.

Journal article
Authors Klara Andersson
Anneli Ozanne
Anna Edelvik Tranberg
John Chaplin
Kristian Bolin
Kristina Malmgren
Johan Zelano
Published in Seizure
Volume 74
Pages 71-76
ISSN 1532-2688
Publication year 2020
Published at Institute of Neuroscience and Physiology
Centre for Health Economics
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Institute of Clinical Sciences, Department of Pediatrics
Institute of Health and Care Sciences
Pages 71-76
Language en
Links dx.doi.org/10.1016/j.seizure.2019.1...
Subject categories Neuroscience, Pediatrics

Abstract

Epilepsy has well-documented associations with low income and low education levels, but the impact of a patient's socioeconomic standing (SES) on the effects of epilepsy have been less studied.We performed a register-based cross-sectional study and asked if SES was associated with more severe epilepsy or limited access to care in Sweden, where health care is universal, and if socioeconomic outcomes (employment and income) differed for persons with epilepsy (PWE) with different levels of educational attainment. The study cohort consisted of all adult patients with an epilepsy diagnosis in the Swedish patient register in 2000-2015 (n = 126,406) and controls (n = 379,131) matched for age, gender, and place of birth.Somatic and psychiatric comorbidities were more common in PWE, while education and income levels were lower. Among PWE, hospitalizations were more common in persons with lower income or education. Having at least one prescription written by a neurologist in the study period was more common in the high-income and high-education groups. Finally, although low educational attainment was associated with low levels of income and inversely associated with employment in both persons with epilepsy and controls, regression analyses demonstrated that these associations were much more noticeable in cases than controls.We conclude that both the severity and consequences of epilepsy are greater in persons of low SES, even in a country with universal health care. This indicates that universal access may not be sufficient to mitigate socioeconomic inequity in epilepsy.

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