Social Determinants Linked to Lower Neurology Use in Veterans With Post-Traumatic Epilepsy
Veterans with post-traumatic epilepsy (PTE) living in more socioeconomically deprived areas are significantly less likely to access specialized neurology services, according to the first large-scale study examining social determinants of health (SDoH) and health care utilization in this population.
The study analyzed data from 6732 veterans with PTE using the Veterans Affairs (VA) Corporate Data Warehouse. Researchers assessed area-level deprivation via the Area Deprivation Index (ADI), based on patients’ ZIP codes, and individual SDoH captured by ICD-10-CM diagnostic codes. Utilization measures included visits to neurology clinics, epilepsy specialty care, magnetic resonance imaging (MRI), electroencephalogram (EEG) use, and seizure-related emergency care.
Veterans in higher ADI quartiles—representing greater area deprivation—had significantly lower utilization of multiple forms of epilepsy-related care:
Neurology clinic visits dropped across increasing ADI quartiles. Compared to the lowest-deprivation quartile, patients in the fourth quartile had a 25.5% lower incidence of visits (IRR, 0.745; 95% CI, 0.690–0.804; P < 0.001).
Access to comprehensive epilepsy specialty care was dramatically reduced in higher-deprivation areas. Veterans in the fourth quartile had a 69.4% lower likelihood of receiving this care (OR = 0.306; 95% CI, 0.235–0.395; P < 0.001).
Neuroimaging (MRI) and EEG testing were also significantly less common in these high-deprivation groups. In contrast, individual-level SDoH coded via ICD-10-CM were not reliably associated with health care utilization patterns. This suggests that broad community-level indicators may offer more actionable insights into disparities in care access for veterans with PTE.
This study underscores the impact of neighborhood-level socioeconomic deprivation on access to essential epilepsy care within the VA system. The findings highlight the importance of incorporating community-level SDoH measures in health care planning to improve equity and outcomes for veterans with complex neurologic conditions like post-traumatic epilepsy.
Reference
Zhou R, Sullivan-Baca E, Bart T, Pugh MJ, Towne A, Haneef Z. Social determinants of health and healthcare utilization in veterans with post-traumatic epilepsy. Epilepsy Res. 2025;216:107594. doi:10.1016/j.eplepsyres.2025.107594
