Approximately three million Americans have epilepsy, a particularly challenging health problem for people in rural areas. To discover how rural residence affects outcomes, Emad Eskandar, M.D., Edward Bader, M.B.Ch.B., M.S., and colleagues at Albert Einstein College of Medicine and Montefiore Health System analyzed more than 840,000 U.S. hospitalizations from 2016 to 2021—the largest study of its kind to date. The findings were published in the June 3 issue of Neurology.

Compared with their urban counterparts, epilepsy patients from the most rural counties were nearly twice as likely to die during hospitalization—a striking disparity not previously documented. Rural patients were also more likely to arrive with status epilepticus (a life-threatening condition in which seizures do not stop), had longer hospital stays, and were somewhat less likely to receive an EEG to monitor brain activity. These differences largely disappeared when the analysis was limited to privately insured patients, suggesting that worse outcomes in rural populations may stem less from geography than from barriers such as limited access to specialists, diagnostic tools, timely care, and specialized epilepsy centers.

Dr. Eskandar, the paper’s senior author, is professor and chair of The Leo M. Davidoff Department of Neurological Surgery, and professor of psychiatry and behavioral sciences and the Dominick P. Purpura Department of Neuroscience at Montefiore Einstein. Dr. Bader, the first author, is a doctoral candidate in the Clinical Investigation Program in Dr. Eskandar’s laboratory.