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Abstract
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Highlights
• Measures of individual and neighborhood-level deprivation were both associated with higher incidence rates of traumatic brain injury.
• In the absence of traumatic brain injury, individual-level deprivation was associated with higher risk of epilepsy in adults, while neighborhood-level deprivation was not associated with risk of epilepsy in any life phase.
• After a traumatic brain injury, the absolute (but not relative) risk of epilepsy was higher in adults of individual-level socioeconomic deprivation, compared to adults without, while the relative (but not absolute) risk of epilepsy was higher in children and adolescents from socially deprived neighborhoods, compared to those of not deprived neighborhoods.
• Jointly, this suggests that socioeconomic disparities operate both at the individual and social level in epilepsy.
Socioeconomic status is a well-recognized predictor of poor health, with findings showing an excess burden of morbidity and mortality in socioeconomically deprived individuals. Epilepsy too, is more prevalent in low-income countries than high-income countries, in persons living in socially disadvantaged neighborhoods, and in persons of lower socioeconomic position, and findings indicate that living in socially deprived areas put individuals at risk of developing epilepsy. Establishing mechanisms behind the increased prevalence of epilepsy in those socially deprived is important to identify modifiable risk factors. One such potential risk factor is traumatic brain injury (TBI) which is a leading cause of acquired epilepsy.
The risk of inflicting a TBI is higher in children and adolescents in socially deprived areas compared to more affluent areas. Generally, injuries are more common in socially disadvantaged children and the elevated epilepsy incidence may reflect increased occurrence of TBIs. Further, socioeconomic determinants, including geographic and financial constraints, restrict access to essential health services. Individuals from lower socioeconomic strata demonstrate decreased engagement in health screenings and preventive interventions, potentially attributable to disparities in health awareness or divergent health beliefs. Injury mechanisms in socially disadvantageous persons mirror more risky behavior such as violence and motor vehicle accidents resulting in high energy trauma. Collectively, such factors may impact the mechanisms and recovery from TBI, reflected by effect heterogeneity of TBI by socioeconomic standing.
In this study, we therefore examined whether the sex- and age-specific risk of TBI and epilepsy after TBI differed according to individual- and neighborhood-level indices of socioeconomic deprivation.
Language: en |