A new study published June 3, 2026, in Neurology^® found that people with epilepsy who live in rural parts of the U.S. may face worse health outcomes when hospitalized compared to those living in urban areas.

Researchers looked at more than 841,000 hospital admissions for adults with epilepsy across the country. They grouped patients by county, ranging from large cities to the most remote areas.

The results showed that people living in the most rural counties had nearly twice the odds of dying in the hospital compared to those in the most urban counties. They were also more likely to arrive at the hospital in status epilepticus—a seizure emergency in which seizures last more than five minutes or happen repeatedly.

Patients in rural areas were more likely to have a longer hospital stay and less likely to receive an EEG—a test used to identify and characterize seizures. They were also less likely to be sent to a rehabilitation or skilled nursing facility after leaving the hospital.

"Epilepsy is a complex condition that requires specialized care with consistent access to antiseizure medications, and delays in care can be critical," said study author Edward R. Bader, MBChB, of the Albert Einstein College of Medicine in New York. "Our study showed living in more rural areas was linked to worse epilepsy health outcomes."

Notably, when researchers looked only at patients with private insurance, the outcomes between people in rural and urban areas were similar. This suggests that factors beyond geography—such as insurance coverage and access to care—may contribute to these differences.

The study was conducted mostly before telehealth expanded during the COVID-19 pandemic. Researchers say telehealth could help close the gap by connecting rural patients with specialists.

The study does not say that living in a rural area causes worse health outcomes. Researchers emphasize that more work is needed to improve access to epilepsy care in rural communities.

Key Takeaways

• In this study, people with epilepsy living in the most rural counties had nearly twice the odds of dying in the hospital compared to people living in the most urban counties.
• Among patients with private insurance, the outcomes between people in rural and urban areas were similar.
• Expanding telehealth services could improve access to specialized epilepsy care for people living in rural areas.

Medically reviewed by Sarah Song, MD, MPH, FAHA, FAAN