High‐resolution mapping of epilepsy prevalence, ambulance use, and socioeconomic deprivation in an urban area of Sweden

Abstract

Objective Geographic differences in epilepsy prevalence between areas of different socioeconomic standing have been demonstrated in the United Kingdom, but knowledge from other health care systems is scarce. Our objective was to compare epilepsy prevalence and emergency medical service (EMS) assignments for seizures in areas of different socioeconomic standings in the urban area of Gothenburg. Methods Register‐based study in Gothenburg (population 690 000), the second largest city in Sweden. Epilepsy cases were identified in the comprehensive national patient register in 2014‐2015. EMS assignments were identified in the EMS dispatch system in 2013‐2018. Socioeconomic variables were mean income and proportion of welfare recipients. Results Significant correlations were seen between epilepsy prevalence and the proportion of welfare recipients (r = .49, P = .0014) and annual income per capita (r = −.42, P = .0071). There were 7907 assignments for seizures during the study years. GPS‐based analysis showed that most assignments occurred in the city center. In addition, several high‐density areas correlated with areas with a high proportion of inhabitants receiving welfare. Correlation analysis showed significant associations between the number of EMS assignments per capita and the proportion of welfare recipients (r = .31, P < .0001) and income (r = −.19, P < .0001). When comparing representative areas, a greater proportion of assignments was given the highest priority in high status areas compared to low status areas, both by the dispatch center and EMS clinicians on scene. Significance Our findings that epilepsy prevalence and seizure frequency differ with socioeconomic status on a microgeographic level considerably strengthen the generalizability of previous observations across different health care systems. Differences in priority may reflect health utilization behavior or access to neurologic care.

Association between social deprivation and incidence of first seizures and epilepsy: A prospective population‐based cohort

“…In Wales, no evidence of social drift was found by following a cohort of patients with incident epilepsy for 10 years 4 . Taken together, studies to date therefore suggest that social causation, rather than social drift, is the dominant factor contributing to the higher prevalence of epilepsy 1–3 in areas of social deprivation. However, investigation of multigenerational clustering of genes that lower seizure threshold would require prolonged follow‐up, multigenerational family history, and detailed genetic analysis of participants and would be difficult to perform at a population level.…”

Network, clinical and sociodemographic features of cognitive phenotypes in temporal lobe epilepsy

“…The possibility that early disadvantage contributed to smaller ICV in Generalized-CI cannot be ruled out. Population-based research has demonstrated higher rates of epilepsy in disadvantaged populations, the disadvantage not due to social drift ( Magnusson and Zelano, 2019 , Pickrell et al, 2015 , Steer et al, 2014 ), and racial and SES factors have been shown to influence features of epilepsy presentation ( Allen et al, 2018 , Allen et al, 2019 ). As disadvantage is known to impact cognition, brain and behavior in the general population, it appears important to more seriously consider these factors in the neuropsychology of epilepsy ( Baxendale and Heaney, 2011 ).…”

Exploring variation in ambulance calls and conveyance rates for adults with diabetes mellitus who contact the Northern Ireland Ambulance Service: a retrospective database analysis

“…This could be due to people from more deprived areas having poorer health literacy and less access to good quality medical care and being encouraged to contact emergency services, particularly out-of-hours ( Peconi et al, 2017 ). Positive correlations have also been shown between deprivation, call rates and population density ( Magnusson & Zelano, 2019 ). This is potentially due to more deprived areas having higher population density and so having more ambulance calls.…”