Social determinants of health (social risk) and epilepsy in older adults living in low-resource rural settings

Background: Information of the link between social risk and epilepsy in remote rural settings is limited. This study aims to assess this association in older adults enrolled in the Three Villages Study cohort. Methods: Following a population-based cross-sectional design, older adults living in rural Ecuador underwent social risk determinations based on social determinants of health components from the Gijon's Social-Familial Evaluation Scale (SFES) together with clinical interviews to determine epilepsy history. Both unadjusted and multivariate logistic regression models were fitted to assess the association between the total Gijon's SFES and each of its components and epilepsy (dependent variable). Results: The study included 682 individuals aged ≥ 60 years (mean age: 68 ± 7.3 years; 55 % women). The mean Gijon's SFES score was 10.1 ± 3.1 points, and the crude prevalence of epilepsy was 35.1 per 1,000 population. In unadjusted analysis participants in the highest tertile of social risk had significantly higher odds of having epilepsy compared to those in the lowest tertile (OR: 5.37; 95 % C.I.: 1.73 – 16.7). This association persisted when age, sex, and level of education were added to the model. Analysis of individual components of the Gijon's SFES showed that only social relationships and support networks were significantly associated with epilepsy. Conclusion: Study results indicate a link between high social risk and epilepsy. The direction of this association remains unclear, but a bidirectional relationship between both variables is likely. Adopting stronger community networks and social support systems could help mitigate epilepsy burden in low-resource settings.