In 2022, Dr Kathryn Bush was awarded an Emerging Leader Fellowship Award to assess socioeconomic inequalities for people living with epilepsy in the UK. Initial findings from this ongoing project have been published in The Lancet Public Health, a prestigious international medical journal. Here, Dr Bush shares more on the project and what the findings mean.
What are ‘socioeconomic inequalities’ in epilepsy?
Inequalities are the differences in health between different groups of people. In our study this includes both how likely they are to develop epilepsy (the rates of epilepsy), or how well people do once they have a diagnosis of epilepsy (health outcomes).
Socioeconomic inequalities are the differences in health between our most deprived and least deprived communities. We can measure socioeconomic inequalities by looking at information from individuals (the types of jobs they have, how much they are paid or their education levels) or at an ‘area level’, according to where people live. The governments across the UK create a score (Index of multiple deprivation/ IMD score) based on many different factors including information about crime rates, housing, education and income. In our study we used both individual and area-level measures to assess levels of deprivation.
What did we do?
We searched for all journal articles and reports that included information about ‘socioeconomic inequalities’ in the United Kingdom between January 1980 and March 2024. We then looked at three main areas:
- How do levels of deprivation affect how likely you are to develop epilepsy in the UK?
- What causes any differences seen?
- How do health outcomes for people with epilepsy differ according to levels of deprivation? In this case we were looking at things like being admitted to hospital, developing other medical conditions, or the risk of dying at an earlier age.
What did we find?
Our searches found 3,536 studies that might include information on our topic in the UK. After reading them, we found that 10 papers had information about who develops epilepsy according to levels of deprivation and 16 studies had information about health outcomes.
We found that if you live in the most deprived areas of the UK, your risk of developing epilepsy is 34% higher than if you live in the least deprived areas. This means that for every 10 people that develop epilepsy in the least deprived areas, 13 will develop epilepsy in the most deprived areas. The risk of epilepsy is increased for both adults and children.
When we looked at the differences in outcomes for people with epilepsy, we found that there was not a lot of evidence on any one topic. The studies that we did find, suggested that people with epilepsy who lived in deprived areas, were more likely to be admitted to hospital as an emergency and more likely to die early, both from epilepsy and other causes.
Why do more people in deprived areas in the UK develop epilepsy?
At the moment we don’t know. In all of the studies that we looked at we found only one thing that appeared to increase the risk of epilepsy, and that was living in London compared to the rest of the South East of England. However, it is important not to be alarmed by this finding – it might for example, be that people with epilepsy are more likely to move to London, to be closer to specialist hospitals. The people living in London were also more deprived than those living outside of London, which could explain the findings as well.
What does this study mean?
This study has shown that there are widespread differences in who develops epilepsy, according to the levels of deprivation where they live. These differences are unfair, unjust and preventable.
What happens next?
We are working with large UK data-sets (linked GP, hospital, census and death data) to try and identify what is causing the differences in who develops epilepsy between the different areas. Once we have identified these factors, we can work out what can be done to try and reduce the risk of epilepsy in our most deprived communities.