A first-of-its-kind nationwide study mapped epilepsy incidence rates among older adults in the United States and identified key social and environmental factors associated with the neurological condition. Published recently in JAMA Neurology, the study is a collaborative effort between researchers at the Houston Methodist Research Institute and Case Western Reserve University. The analysis revealed that epilepsy cases among adults age 65 and older were significantly higher in areas of the South, including Louisiana, Mississippi, East Texas and central Oklahoma, compared to other areas.
Epilepsy affects about 3.3 million people in the United States, according to the US Centers for Disease Control and Prevention. In 2019, health care spending for epilepsy and seizures reached $24.5 billion.
In that context, the study’s lead investigator, Weichuan Dong, Ph.D., assistant professor at Houston Methodist DeBakey Heart & Vascular Center and assistant professor at Case Western Reserve University, said the research offers critical insight into how epilepsy affects the elderly that could prevent care renewal nationwide. for this neurological condition.
Until now, we haven’t had a national picture of where epilepsy affects older people the most. By applying advanced geospatial mapping to Medicare data, we uncovered striking clusters of high epilepsy rates in areas of the South—what we call the “epilepsy belt.” “Understanding where the burden lies is the first step to uncovering why and helping communities reduce risk.”
Weichuan Dong, Ph.D., assistant professor, Houston Methodist DeBakey Heart & Vascular Center and adjunct assistant professor, Case Western Reserve University
The study also found that the most important factors associated with a higher incidence of epilepsy included insufficient sleep (fewer than seven hours a night), extreme heat (more days with a heat index above 95 degrees), lack of physical activity, lack of health insurance in young adults (indicating delayed diagnosis until Medicare eligibility), and limited access to a household vehicle. These conditions, often shaped by local environment and socioeconomic status, were more prevalent in areas with the highest rates of epilepsy.
“This is the first study to document such a strong association between extreme heat and incident epilepsy in older US adults, highlighting the importance of climate change in emergency preparedness, especially given the graying of the population,” said Siran Koroukian, Ph.D., professor in the Department of Population and Quantitative Health Sciences at Case Western Reserve University School of Medicine.
Using advanced geospatial machine learning algorithms, researchers analyzed data from 4.8 million Medicare beneficiaries between 2016 and 2019. Data sources included the US Master Beneficiary Abstract File and the Agency for Healthcare Research and Quality. Alaska and Hawaii were excluded due to missing data from the Social and Environmental Determinants of Health report.
The study revealed patterns previously unseen in national data, showing how factors such as neighborhood sleeping patterns, heat exposure, access to health care and access to household vehicles can shape health outcomes. Other strong predictors included the prevalence of obesity and the availability of primary care physicians.
Study collaborators were Alex Cabolong, Long Vu, Hannah Fein, Nicolas Schiltz and Martha Sajatovic from Case Western Reserve University. Sadeer Al-Kindi of the Houston Methodist Heart and Vascular Center. David Warner from the University of Alabama at Birmingham and Bowling Green State University. and Gena Ghearing from Mount Sinai Health System.
This work was supported in part by a grant from the Centers for Disease Control and Prevention of the US Department of Health and Human Services (U48 DP006404-03S7) and the Center for Family and Demographic Research, Bowling Green State University (P2CHD050959). Additional support was provided by the Center for Health Systems Management Leadership Fund from Case Western Reserve University.
