1. To investigate historical trends in the representations of “diversity” (e.g., race or ethnicity/culture, disability status, age, biological sex or gender, economic status, and sexual orientation) in medical texts related to epilepsy.

2. To explore themes (e.g., sentiments) surrounding these diversity-related terms.

“Diversity” is a hot-button topic in our society with polarizing views. Constructs for diversity encompass a wide range of group membership categories. Social determinants of health (SDOH), a framework for understanding demonstrated health differences between groups of patients taking into account non-medical factors, often intersect with diversity categories. In epilepsy, several studies have shown that people living with seizures from (racial/ ethnic) minoritized communities or socioeconomically disadvantaged groups (as proxies for SDOH) can have suboptimal healthcare access and clinical outcomes. If some health differences in people living with epilepsy today are linked to diversity, then how has the depiction of diversity in medical literature evolved over time? 

A quantitative/qualitative retrospective longitudinal analysis of curated medical texts in the H. Richard Tyler collection. We created copies of the original texts as searchable PDF files. Using WordStat, we analyzed diversity term word frequency and content themes (negative/positive sentiment) using customized categorization dictionaries.

N = 29 texts were included, published between 1822-1992. Keywords from all predefined diversity categories were identified; disability status was the most frequent category. Non-White race was represented ~54% as often as White race with no significant increase over time. Sexual orientation was the least represented diversity category. The frequency of diversity terms was lower than the ten major common topics in the medical texts, although not statistically significant (P(T<=t); p=0.19, two-sample t-Test). Diversity terms were most frequently associated with negative sentiment words in all categories.

Historically, diversity has often been referenced negatively and has not been a primary focus in healthcare related to epilepsy.