A triple burden in native Hawaiian and Pacific Islander patients with epilepsy: The cardiometabolic risks of obesity, diabetes, smoking, and their association with seizure control.

BACKGROUND

People with epilepsy (PWE), particularly Native Hawaiians and Pacific Islanders (NHPI), face significant cardiometabolic disparities. This study characterized the "triple burden" of obesity, diabetes, and tobacco use across White, Asian, and NHPI PWE in Hawaii and identified factors associated with seizure control.

METHODS

A retrospective chart review of 403 adult PWE (41.2% White, 24.1% Asian, 34.7% NHPI) was conducted at a Hawaii-based clinic. Multivariable logistic regression compared comorbidity profiles and identified factors associated with poor seizure control (breakthrough or drug-resistant).

RESULTS

After adjustment, NHPI patients faced significantly higher odds of obesity (OR=2.03, 95% CI [1.26-3.28]), diabetes (OR=2.97, 95% CI [1.42-6.21]), and tobacco use (OR=1.89, 95% CI [1.06-3.34]) compared to White patients. Current tobacco use was the strongest factor associated with poor seizure control (OR=2.08, 95% CI [1.12-3.89], p = 0.021). Obesity (p = 0.149) and diabetes (p = 0.933) were not significantly associated with seizure outcomes.

CONCLUSION

NHPI PWE face a disproportionate triple burden of cardiometabolic risks. While all are critical for health, tobacco use was the only factor independently associated with poor seizure control. These findings underscore the importance of culturally tailored smoking cessation programs to address risk as both a behavioral and cardiometabolic condition as a supportive intervention to improve neurologic outcomes in this population.