Perceptions of health disparities among neurologists treating Black patients with epilepsy: A survey study in the United States

Objective: Many factors influence patients’ experience with epilepsy, including inequities based on socially defined race and ethnicity. We sought to better understand factors contributing to health disparities in Black people living with epilepsy (PWE), as perceived by neurologists, and the value of programs to help healthcare providers (HCPs) reduce these disparities. Methods: An online, blinded, cross-sectional survey was administered to neurologists (November 8–18, 2022) whose population of PWE included ≥ 20 % of Black individuals and who had managed ≥ 10 PWE in the last 30 days. Questions assessed recognition of health disparities in PWE and the value of HCP-focused programs to address disparities. Statistical comparisons were performed by practice setting (academic vs. community). Results: Of 101 neurologists, 48.5 % and 51.5 % worked in academic and community settings, respectively, 2.0 % of all neurologists were Black, and 28.3 % of neurologists’ patients were Black. Situations most commonly having a major/severe negative health impact were ‘inconsistent treatment adherence/compliance’ and ‘have significant comorbidities’ in all PWE, and ‘missed appointments’ and ‘mistrust in the healthcare system’ in Black PWE. In total, 27.7 % of neurologists (42.9 % academic vs. 13.5 % community-based; p < 0.05) completely agreed that racism is a social determinant of health (SDOH). HCP-focused programs were generally considered as somewhat/very important to improve outcomes in Black PWE. Conclusions: Fewer than a third of neurologists completely agreed that racism is an SDOH, variably suggesting no perceived differences in their patient populations (leading to disagreement) or providing evidence of implicit/unconscious bias. Increasing neurologists' participation in HCP-focused programs may help counter health disparities in Black PWE, or at a minimum improve awareness that disparities exist.