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339069
Racial and Ethnic Variances in the Relationship between Autism and Epilepsy in Children: Multilevel Analysis using NSCH, 2012


Monday, November 2, 2015

Laurens Holmes Jr., MD, DrPH, Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Joseph Casini, BS(c), Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Isabel Morgan, BA, MSPH(c), Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Patricia Oceanic, MS, CDM, Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Kirk Dabney, MD, MHCDS, Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Purpose: Autistic Spectrum Disorder (ASD) tends to co-occur with epilepsy, but it is not fully understood if autism predisposes to epilepsy or vice versa. We aimed to assess the relationship between ASD and epilepsy and to determine whether or not this relationship varies by race/ethnicity.

Methods: Using the National Survey of Children’s Health 2012 (NSCH) data, we assessed the prevalence of ASD, epilepsy, and epilepsy-ASD as a comorbidity among children ages 2-17 years. A multilevel analysis was performed using a binomial regression model in order to examine the risk markers for comorbidity as well as the racial variance.

Results: Of 95,775 children surveyed, the prevalence of epilepsy was n=579 (0.7%), ASD, n=1,624 (1.9%) and comorbidity n=101 (0.12%). There was racial/ethnicity disparity in epilepsy, with prevalence higher among Blacks (1.0%) relative to Whites (0.7%), x2(2)=15.7, p<0.001. Compared to White children, African American/Black children were 66% more likely to be diagnosed with epilepsy. Similarly, ethnic variance was observed in the prevalence of epilepsy with Non-Hispanic Blacks having the highest prevalence (1.1%), Non-Hispanic Whites (0.7%), Hispanics (0.5%), x2(3)=20.5, p<0.001. In contrast ASD was more prevalent among Whites (2.0%) and lower among Blacks (1.6%). Relative to Hispanics, White Non-Hispanics were significant 58% more likely to be diagnosed with autism (RR=1.58 95% CI 1.32-1.87). The co-occurrence of epilepsy and autism was n=101 (17.4%), Whites, 18.6% (n=76), 13.6% Blacks (n=12). Additionally, there was racial variance in comorbidity, with Blacks more likely to be diagnosed with dual conditions, prevalence risk ratio=1.20, 95%CI=0.64-2.24. After controlling for sex, insurance and intellectual disability, the racial differences between Black and White with respect to the comorbidity did not persist, adjusted prevalence risk ratio (APRR) = 1.01, 99% CI, 0.43-2.35, p = 0.97.

Conclusion: Racial disparities exist in ASD, epilepsy and the comorbidity among children in the US. However, racial variance in comorbidity did not persist after controlling for the risk markers. These findings suggest cautious optimism in assessing whether or not epilepsy contributes to autism or autism contributes to epilepsy given the high prevalence of this comorbidity in children.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Epidemiology
Public health or related public policy
Public health or related research

Learning Objectives:
Assess the relationship between epilepsy and autism among children Examine racial heterogeneity in the relationship between epilepsy and autism Explain racial heterogeneity using multilevel analysis

Keyword(s): Child Health, Children With Special Needs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The primary author conceptualized the study and the design, analyzed the data, interpreted the results, prepared the manuscript and the final draft.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3205.2: Late Breaker Poster Session: Recent Findings in Public Health Epidemiology