To examine access to specialty epilepsy care across race, gender, and rural/urban status in the Veterans Health Administration (VA).

A retrospective cross-sectional design was used to compare the proportion of Veterans with Epilepsy (VWE) who received epilepsy specialty care. Nationwide data, including demographic variables, prescriptions of newer versus older anti-seizure medications (ASM), neuroimaging ordered, referral to an inpatient epilepsy monitoring unit (EMU), and electroencephalogram (EEG) ordered during FY2015-FY2019, were collected. 

Statistical Analysis. Chi square tests of independence were carried out to determine the association of race with categorical variables and a t-test was performed for difference in age.

A total of 75,003 VWE were included in the analysis. Whites (WVWE) comprised 77.1%  (n=57,839) and African Americans (AAVWE) 22.9% (n=17,164) of the sample. AAVWE had a larger proportion of women (11.8% of AAVWE vs. 8.0% of WVWE). AAVWE were relatively slightly younger with an average age 62.0 and standard deviation (s.d.) of 13.2 than WVWE (mean 63.2, s.d. 15) (p value <0.001). AAVWE were more likely to live in urban centers 81.9%) compared to WVWE (59.8%). AAVWE were more likely to have EEG ordered (36.1% vs 30.6%), MRI ordered (40.8% vs 35.7%), CT ordered (49.4% vs 39.4%), be seen at an ECOE (12.3% vs 10.5%) and seen by a neurologist (69.0% vs 62.1%) (p<0.0001). AAVWE and WVWE were referred to an EMU in approximately the same proportion (3.2% vs 3.0%) (p=0.07).  

A larger proportion of AAVWE were offered specialty epilepsy care compared to WVWE. More AAVWE lived in urban centers where more epilepsy specialist and diagnostic tools are available, which may account for improved access to care.