Healthy People 2020 (HP2020), a national health promotion initiative, calls for increasing the proportion of U.S. adults who self-report good or better health [1]. Underlying the focus on “good or better health” is an asset-based paradigm that emphasizes protective factors and conditions that may foster health and resilience [1,2]. For HP2020, the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Scale (GHS) provides a reliable and valid set of items of self-reported physical and mental health to monitor these two domains across the decade [1,3]. Using advanced psychometric methods, PROMIS developed a standardized set of generic measures, including the GHS, to facilitate measurement of health among individuals with various conditions and demographic characteristics, enabling cross-disease comparisons [4,5] A previous study examined several psychosocial outcomes including self-rated physical and mental health among adults with active epilepsy measured with the PROMIS GHS [6]. The purpose of this study was to examine the percentage of adults with an epilepsy history who meet the Healthy People 2020 targets for self-reported good or better health and to compare these percentages to adults with history of other common chronic conditions.

Using the 2010 National Health Interview Survey, we compared and estimated the age-standardized prevalence of reporting good or better physical and mental health among adults with five selected chronic conditions including epilepsy, diabetes, heart disease, cancer, and hypertension. Adults’ chronic condition statuses were assessed by a “Yes” response to a survey question that asked if they have ever been told by a doctor or other health professional that they have this condition. Individuals with multiple chronic conditions, in addition to the unique condition assessed, were used in the analysis. Adults’ reported physical and mental health were assessed through scales containing eight PROMIS measures [3]. As described elsewhere [3,6], the physical health scale measures fatigue and pain in the past seven days, everyday physical activities, and general physical health.¹ The mental health scale measures emotional problems in the past seven days, satisfaction with social activities/relationships, general quality of life, and general mental health.² After we appropriately recoded and rescored each PROMIS item [3], both physical and mental scales ranged from 4 to 20 points. Consistent with HP2020 methodology, we used fifteen points as the cutoff point for good and better physical health and fourteen points for good and better mental health [3,7]. We examined response patterns for the physical and mental health scales among adults with these five conditions after age-standardizing these percentages to the year 2000 US population. We considered these percentages statistically significantly different at a significance level of 0.05 if their 95% confidence intervals did not overlap.

Among 480 adults reporting an epilepsy history (1.8%, 95% CI: 1.6–1.9%) of 27,139 survey respondents included in the study [6], only about 52% reported good or better physical health, compared to 79% of all adults who self-reported good or better physical health [1]. The percentage of adults with an epilepsy history who reported good or better physical health was significantly less than the percentages of adults with heart disease, cancer, and hypertension who reported good or better physical health (Fig. 1). About 54% of adults with an epilepsy history reported good or better mental health, compared to 79% of all adults who self-reported good or better mental health [1]. The percentage of adults with an epilepsy history who reported good or better mental health was significantly less than the percentage of adults with all other four selected conditions who reported good or better mental health (Fig. 1). The percentages of adults with epilepsy who reported good or better physical or mental health were significantly below the HP 2020 target estimate of 80% for both outcomes (Fig. 1).

Adults with an epilepsy history are well below national averages for the percentages of adults who report good or better mental and physical health, and they fare significantly worse on positive mental and physical health functioning than adults with other common chronic conditions such as heart disease and cancer. Correlates of low levels of health-related quality of life and well-being are attributed to multiple condition-, treatment-, individual-, and social-related factors that have been extensively described [8]. However, findings in this study supplement previous findings among those with active epilepsy [6] and underscore the marked disparities in positive physical and mental health functioning that persist for U.S. adults with an epilepsy history, including those with active epilepsy despite advances in treatment and care. These findings also underscore an urgency to prioritize epilepsy prevention efforts to reduce health and social disparities [9].

Similar to those reported in Kobau et al. [6], this study has several limitations including the possibility of recall or reporting biases among survey respondents. The data are cross-sectional so associations between study outcomes and epilepsy are not necessarily causal. Participation in NHIS requires English fluency and functional capacity, so that the study may have excluded some adults. Finally, we examined epilepsy history to facilitate comparisons with adults with a history of other common conditions examined—as it was not possible to confirm whether survey respondents had each condition when surveyed. Strengths of the study include the large, nationally representative sample of adults with epilepsy; use of age standardization to avoid confounding by age, use of a conservative statistical approach; and the use of psychometrically robust health assessment measures. Health and social service providers can implement and enhance existing evidence-based clinical interventions and public health programs and strategies shown to improve outcomes in epilepsy. These estimates can be used to assess improvements in the Healthy People 2020 Health-Related Quality of Life and Well-Being Objective throughout the decade.