Socioeconomic differences in use of antiseizure medication in pregnancies with maternal epilepsy: A population-based study from Nordic universal health care systems.
access to care
antiepileptic drugs
disparities
pregnancy
socioeconomic factors
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
28 May 2024
28 May 2024
Historique:
revised:
08
05
2024
received:
29
11
2023
accepted:
08
05
2024
medline:
28
5
2024
pubmed:
28
5
2024
entrez:
28
5
2024
Statut:
aheadofprint
Résumé
Research points to disparities in disease burden and access to medical care in epilepsy. We studied the association between socioeconomic status (SES) and antiseizure medication (ASM) use in pregnancies with maternal epilepsy. We conducted a cross-sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006-2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%-4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference. Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03-1.57) to aRR = 1.66 for low education (95% CI: 1.30-2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88-2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29-2.24) and in polytherapy (aRR 2.65; 95% CI 1.66-4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08-1.26) to 1.26 (not married or cohabiting; 95% CI 1.17-1.36). Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Norges Forskningsråd
ID : 262700
Organisme : Norges Forskningsråd
ID : 273366
Organisme : Norges Forskningsråd
ID : 328615
Organisme : NordForsk
ID : 83539
Organisme : NordForsk
ID : 83796
Informations de copyright
© 2024 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
Références
Mackenbach JP. The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc Sci Med. 2012;75(4):761–769.
van Doorslaer E, Masseria C, Koolman X. OECD health equity research group. Inequalities in access to medical care by income in developed countries. CMAJ. 2006;174(2):177–183.
Ahmed S, Shommu NS, Rumana N, Barron GRS, Wicklum S, Turin TC. Barriers to access of primary healthcare by immigrant populations in Canada: a literature review. J Immigr Minor Health. 2016;18(6):1522–1540.
Andersson K, Ozanne A, Edelvik Tranberg A, E Chaplin J, Bolin K, Malmgren K, et al. Socioeconomic outcome and access to care in adults with epilepsy in Sweden: a nationwide cohort study. Seizure. 2020;74:71–76.
Hansen AH, Halvorsen PA, Ringberg U, Førde OH. Socio‐economic inequalities in health care utilisation in Norway: a population based cross‐sectional survey. BMC Health Serv Res. 2012;25(12):336.
Sinnott SJ, Buckley C, O'Riordan D, Bradley C, Whelton H. The effect of copayments for prescriptions on adherence to prescription medicines in publicly insured populations; a systematic review and meta‐analysis. PLoS One. 2013;8(5):e64914.
Elliott JO, Lu B, Shneker BF, Moore JL, McAuley JW. The impact of ‘social determinants of health’ on epilepsy prevalence and reported medication use. Epilepsy Res. 2009;84(2–3):135–145.
Hope OA, Harris KM. Management of epilepsy during pregnancy and lactation. BMJ. 2023;8(382):e074630.
Gedzelman E, Meador KJ. Antiepileptic drugs in women with epilepsy during pregnancy. Ther Adv Drug Saf. 2012;3(2):71–87.
Szaflarski M. Social determinants of health in epilepsy. Epilepsy Behav. 2014;41:283–289.
Svendsen MT, Bak CK, Sørensen K, Pelikan J, Riddersholm SJ, Skals RK, et al. Associations of health literacy with socioeconomic position, health risk behavior, and health status: a large national population‐based survey among Danish adults. BMC Public Health. 2020;20(1):565.
Hamade YJ, Palzer EF, Helgeson ES, Hanson JT, Walczak TS, McGovern RA. Persistent racial and ethnic disparities as a potential source of epilepsy surgery underutilization: analysis of large national datasets from 2006‐2016. Epilepsy Res. 2021;176:106725.
Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–706.
Lupattelli A, Wood ME, Nordeng H. Analyzing missing data in perinatal Pharmacoepidemiology research: methodological considerations to limit the risk of bias. Clin Ther. 2019;41(12):2477–2487.
Rubin D. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987.
Szaflarski M, Wolfe JD, Tobias JGS, Mohamed I, Szaflarski JP. Poverty, insurance, and region as predictors of epilepsy treatment among US adults. Epilepsy Behav. 2020;107:107050.
Leinonen MK, Campbell S, Ursin G, Tropé A, Nygård M. Barriers to cervical cancer screening faced by immigrants: a registry‐based study of 1.4 million women in Norway. Eur J Pub Health. 2017;27(5):873–879.
Cohen JM, Cesta CE, Furu K, Einarsdóttir K, Gissler M, Havard A, et al. Prevalence trends and individual patterns of antiepileptic drug use in pregnancy 2006‐2016: a study in the five Nordic countries, United States, and Australia. Pharmacoepidemiol Drug Saf. 2020;29(8):913–922.
Charlton R, Garne E, Wang H, Klungsøyr K, Jordan S, Neville A, et al. Antiepileptic drug prescribing before, during and after pregnancy: a study in seven European regions. Pharmacoepidemiol Drug Saf. 2015;24(11):1144–1154.
Man SL, Petersen I, Thompson M, Nazareth I. Antiepileptic drugs during pregnancy in primary care: a UK population based study. PLoS One. 2012;7(12):e52339.
Madley‐Dowd P, Rast J, Ahlqvist VH, Zhong C, Martin FZ, Davies NM, et al. Trends and patterns of antiseizure medication prescribing during pregnancy between 1995 and 2018 in the United Kingdom: a cohort study. BJOG. 2024;131(1):15–25.
Pardo‐Crespo MR, Narla NP, Williams AR, Beebe TJ, Sloan J, Yawn BP, et al. Comparison of individual‐level versus area‐level socioeconomic measures in assessing health outcomes of children in Olmsted County, Minnesota. J Epidemiol Community Health. 2013;67(4):305–310.
Moss JL, Johnson NJ, Yu M, Altekruse SF, Cronin KA. Comparisons of individual‐ and area‐level socioeconomic status as proxies for individual‐level measures: evidence from the mortality disparities in American communities study. Popul Health Metrics. 2021;19(1):1.
Gollwitzer S, Kostev K, Hagge M, Lang J, Graf W, Hamer HM. Nonadherence to antiepileptic drugs in Germany: a retrospective, population‐based study. Neurology. 2016;87(5):466–472.
Burneo JG, Jette N, Theodore W, Begley C, Parko K, Thurman DJ, et al. Disparities in epilepsy: report of a systematic review by the north American Commission of the International League against Epilepsy. Epilepsia. 2009;50(10):2285–2295.
Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014;129(Suppl 2):19–31.
von Gaudecker JR, Buelow JM, Miller WR, Tanner AL, Austin JK. Social determinants of health associated with epilepsy treatment adherence in the United States: a scoping review. Epilepsy Behav. 2021;7(124):108328.
Lai ECC, Hsieh CY, Su CC, Yang YHK, Huang CW, Lin SJ, et al. Comparative persistence of antiepileptic drugs in patients with epilepsy: a STROBE‐compliant retrospective cohort study. Medicine (Baltimore). 2016;95(35):e4481.
Askarieh A, MacBride‐Stewart S, Kirby J, Fyfe D, Hassett R, Todd J, et al. Delivery of care, seizure control and medication adherence in women with epilepsy during pregnancy. Seizure. 2022;100:24–29.
Rackin HM, Morgan SP. Prospective versus retrospective measurement of unwanted fertility: strengths, weaknesses, and inconsistencies assessed for a cohort of US women. Demogr Res. 2018;39:61–94.
Deogan C, Abrahamsson K, Mannheimer L, Björkenstam C. Having a child without wanting to? Estimates and contributing factors from a population‐based survey in Sweden. Scand J Public Health. 2022;50(2):215–222.
Rasch V, Knudsen LB, Wielandt H. Pregnancy planning and acceptance among Danish pregnant women. Acta Obstet Gynecol Scand. 2001;80(11):1030–1035.
Bensken WP, Fernandez Baca Vaca G, Alberti PM, Khan OI, Ciesielski TH, Jobst BC, et al. Racial and ethnic differences in Antiseizure medications among people with epilepsy on Medicaid: a case of potential inequities. Neurol Clin Pract. 2023;13(1):e200101.
Mattsson P, Tomson T, Eriksson O, Brännström L, Weitoft GR. Sociodemographic differences in antiepileptic drug prescriptions to adult epilepsy patients. Neurology. 2010;74(4):295–301.
Zhu Q, Guo Y, Ma S, Yang L, Lin Z, Sun H, et al. Sociodemographic factors associated with the first administration of anti‐seizure medication in patients with focal epilepsy in Western China. BMC Neurol. 2021;21(1):251.
Andersson K, Ozanne A, Bolin K, Tomson T, Zelano J. Valproic acid and socioeconomic associations in Swedish women with epilepsy 2010‐2015. Acta Neurol Scand. 2021;143(4):383–388.
Hamer HM, Kostev K. Sociodemographic disparities in administration of antiepileptic drugs to adults with epilepsy in Germany: a retrospective, database study of drug prescriptions. CNS Drugs. 2014;28(8):753–759.
Gaudio M, Konstantara E, Joy M, van Vlymen J, de Lusignan S. Valproate prescription to women of childbearing age in English primary care: repeated cross‐sectional analyses and retrospective cohort study. BMC Pregnancy Childbirth. 2022;22(1):73.
Campbell E, Hunt S, Kinney MO, Guthrie E, Smithson WH, Parsons L, et al. The effect of socioeconomic status on treatment and pregnancy outcomes in women with epilepsy in Scotland. Epilepsy Behav. 2013;28(3):354–357.
Kobau R, Luncheon C, Greenlund K. Active epilepsy prevalence among U.S. adults is 1.1% and differs by educational level‐National Health Interview Survey, United States, 2021. Epilepsy Behav. 2023;142:109180.