Geographic and Sociodemographic Disparities in Epilepsy Incidence Among Older U.S. Adults

A recent study published in JAMA Neurology highlights significant geographic and sociodemographic disparities in the incidence of epilepsy among older adults in the United States. Researchers utilized a large dataset from Medicare administrative claims between 2016 and 2019, analyzing a random sample of 4.8 million Medicare fee-for-service beneficiaries across nearly all U.S. counties. The study notably oversampled non-Hispanic Black and Hispanic populations to assess variation more accurately among diverse demographic groups. The study aggregated county-level data into 692 regional clusters termed 'MaxCounties,' each containing at least 11 new epilepsy cases, revealing a more than tenfold variation in incidence rates across these clusters. Incidence ranged from 141 to 1,476 cases per 100,000 individuals, with higher epilepsy rates concentrated in certain geographic regions, particularly across parts of the Southern U.S., termed the 'epilepsy belt.' Key factors correlated with elevated epilepsy incidence included insufficient sleep, higher heat index values, physical inactivity, lack of health insurance, a higher proportion of non-Hispanic Black residents, obesity prevalence, and limited access to household vehicles. The analysis indicated that MaxCounties with the highest levels of insufficient sleep had nearly double the odds of high epilepsy rates compared to those with the lowest levels, underscoring the potential role of lifestyle and socioeconomic determinants. This research provides a spatial epidemiological perspective on epilepsy within the U.S. elderly population, highlighting health disparities influenced by environmental, behavioral, and sociodemographic factors. The identification of geographic clusters with elevated incidence suggests potential areas for targeted public health interventions and further investigations into underlying causes. Understanding the geographic distribution and associated risk factors is critical for healthcare payers, providers, and policy makers focused on improving neurological health outcomes and managing care for aging populations. This study underscores the importance of incorporating social determinants and local environmental conditions into risk assessments and health strategy planning for chronic neurological conditions like epilepsy.