1. Socio-demographic Profile and Health Status of Patients from the Puerto Rico Epilepsy Comprehensive Program, 2001-2002
Carmen J. Buxó-Martínez, MPH, Manuel Santiago-Cabrera, MPH, Linnette Rodríguez-Figueroa, MS, and the Public Health Field Laboratory Group, 2002*.
University of Puerto Rico, Medical Sciences Campus, Graduate School of Public Health, Department of Biostatistics and Epidemiology
Abstract
Objective: To describe the socio-demographic profile and health status of patients that
participated in the Puerto Rico Epilepsy Comprehensive Program (PROCEPTM, in
Spanish) of the Adult University Hospital in San Juan, Puerto Rico, during the period
of June 2001 to May 2002.
Methods: A cross-sectional study was performed by reviewing 155 available medical
records. The sample consisted of patients ≥ 18 years old with untreatable epilepsy.
Data was analyzed using descriptive statistics, z Test, Chi-Square Test, and Fisher's
Exact Test.
Results: Sixty-one percent of the patients were women, almost half (46.1%) reported
to be never married, 59.1% resided in the Metropolitan Region, and most (58.0%) had
private health insurance. Although 61.8% of the patients reported to be high school
graduates, 27.1% of these were unemployed. Median age of onset of epilepsy was
significantly higher in women (19 vs. 14 years). About 44.5% of the patients had a
diagnosis of partial epilepsy. Most of the patients (56.8%) reported emotional stress as
a precipitant factor for seizure. The most common etiologic factor in men was mental
retardation (18.3%); in women, it was febrile convulsions (23.1%). The most
commonly used medications were: Lamictal, Keppra, and Dilantin. Statistically
significant differences were reported in the use of Lamictal and Dilantin by health
insurance type.
Conclusion: Most results are similar to data reported previously in other studies
worldwide. Further analytic epidemiological studies are recommended to evaluate
epilepsy in Puerto Rico.
Introduction
Epilepsy is a chronic neurologic condition characterized by abnormal
electrical discharges in the brain (seizures) that can cause involuntary changes
in body movement or function, sensation, awareness/behavior.
Seizures are classified in two groups:
Partial: when one part of the brain is involved; most common in adults.
Generalized: when all the brain is involved; commonly developed during
childhood.
Epilepsy is the most prevalent neurological condition in the world
(8.2/1,000). Its distribution varies according to geographic regions (1.5 to
57/1,000). Incidence and prevalence higher in men, although women are the
most common sufferers in USA.
It affects more than 2.7 million people in USA (approximately 181,000 new
cases annually).
Incidence rates for developing countries are twice as high as those in
developed countries, mainly due to the high injury and permanent cerebral
damage risks experienced in developing countries.
Epilepsy is most commonly expressed during early childhood and in people
over sixty, and is associated with a relatively high mortality rate (>2.2 times
higher than in the general population).
In 70% of the cases, there is no identifiable cause, but some seizures can
occur with: high fever, head trauma, brain tumors, poisoning, infections,
increase in intracraneal pressure, temporary chemical imbalance, hereditary
conditions, and problems during fetal development.
Epilepsy has a grave psychosocial impact on persons affected, including:
physical and psychological incapability, difficulties adjusting to society that
can result in substantial incapability, economical losses, and deterioration in
the quality of life.
In Puerto Rico, hardly anything is known about the magnitude and
determinants of this condition.
Objectives
Describe the socio-demographic profile and health status of patients that
visited the ambulatory clinics of the Puerto Rico Epilepsy Comprehensive
Program (PROCEPTM) of the University of Puerto Rico, between June
2001 and May 2002.
Identify the types of epilepsy and age of onset in patients.
Determine if there are differences by gender and type of health insurance
(public or private) in relation to the socio-demographical characteristics
and health status in patients.
Methods
Results
Socio-demographic
Sixty-one percent of the patients were women.
Mean age of sample was 35.7 years.
Almost half (46.1%) reported to be married.
Most of the patients (59.1%) resided in the Metropolitan Region.
More than half (61.8%) of the patients reported to be high school
graduates. However, 27.1% of them reported to be unemployed.
Health Status
Most of the patients (58.0%) had private health insurance.
Epilepsy median age of onset was significantly higher in women (19 vs. 14
years).
About 44.5% of the patients had a diagnosis of partial epilepsy.
Most of the patients (56.8%) reported emotional stress as a precipitant
factor of seizure.
* p<0.05
* p<0.05
* p<0.05
Conclusions
Most of the patients that visited PROCEPTM during the study period were
women, reported to be never married, lived in the metropolitan region, and
had graduated from high school. However, a high proportion of them were
unemployed.
Men reported a statistically significant lower age of onset of epilepsy.
The main medical conditions considered to be etiologic factors for epilepsy
in our study group were mental retardation (in men) and febrile
convulsions (in women).
The most commonly used medications were: Lamictal, Keppra and
Dilantin. Statistically significant differences were reported in the use of
Lamictal and Dilantin by type of health insurance.
The type of epilepsy most commonly reported was partial.
Emotional stress was the most reported seizure precipitant factor.
Most patients perceived that epilepsy limited their social life.
Most of the patients had private health insurance.
In general, no statistically significant differences were found in the socio-
demographic characteristics and health status of patients by health
insurance plan, except for the use of Lamictal and Dilantin. These
differences could be explained by the medication coverage of each health
insurance plan.
Recommendations
Increase awareness about the importance of prenatal care to prevent
neurological conditions associated with epilepsy.
Additional efforts to create educational programs should be done to prevent
risk factors during early childhood.
Medical and social agencies must be encouraged to create programs that
improve the quality of life of patients with epilepsy.
Increase medical research related with medications.
Perform analytical epidemiological studies using a larger sample to study
the risk factors of epilepsy among Hispanics, specially among Puerto
Ricans.
Acknowledgments
PROCEPTM Staff
Dr. Raúl Cruz, PROCEPTM Medical Director
Dr. Judith Román, Department of Neurology, University of Puerto Rico
*Public Health Field Laboratory Group, 2002
José A. Alvarado, MPH
Neichma S. Fargas, MPH
Rosángela L. Fernández, MD, MPH
Yamaris Lebrón, MPH
Carlos R. Maldonado, MPH
Camil I. Marrero, MPH
Jaleann M. Matos, MPH
Yiamira S. Oquendo, MPH
Carlos E. Pérez, MPH
Angienelly Santiago, MPH
Luis J. Santiago, MPH
Adriana Toro, MPH
Samaris O. Vega, MPH
Population:
161 PROCEPTM Patients
Inclusion Criteria:
≥ 18 years old, Born in Puerto Rico,
≥ 1 visits to the clinic and Active Patient
Sample:
155 Active Patients
Design: Descriptive
Medical Record Review
Medical Questionnaire Medical Pre-evaluation
Health Status:
Type of epilepsy, Limitations due to
epilepsy, Number of visits, Medical history
Socio-demographic:
Type of insurance, Sex, Age, Occupation
Marital status, Residence, Educational level
Fisher’s Exact Test:
Qualitative Variables
by Gender and
Health Insurance
Analyses: Epi Info 6/SPSS 9 (α= 0.05)
Data Entry: Epi Info 6
Chi Square:
Qualitative Variables
by Gender and
Health Insurance
Z test:
Quantitative Variables
by Gender and
Health Insurance