Rural Living Linked to Worse Hospital Outcomes for People with Epilepsy

A large study of more than 841,000 hospital admissions found that people with epilepsy living in the most rural U.S. counties experienced worse hospital outcomes than those living in the most urban areas. Researchers found that patients from the most rural counties had nearly twice the odds of dying during hospitalization, were more likely to arrive at the hospital in status epilepticus (a seizure emergency), and were more likely to have prolonged hospital stays. They were also less likely to receive an EEG or be discharged to rehabilitation or skilled nursing facilities.

Importantly, many of these disparities were reduced or disappeared among patients with private insurance, suggesting that access to healthcare resources and coverage may play a significant role in the differences observed. The findings add to growing evidence that people with epilepsy in rural communities face barriers to specialized neurological care and highlight the need for strategies to improve access, including expanded telehealth services.

The study was observational and cannot determine whether rural residence directly causes poorer outcomes. Researchers were also unable to account for factors such as seizure frequency, medication adherence, or local emergency medical service availability. Because much of the data were collected before telehealth became widely available during the COVID-19 pandemic, future research will be needed to determine whether expanded virtual care can help reduce these rural–urban disparities.

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