Epilepsy-Associated Labor Force Exclusion in a NHPI Multi-Ethnic Cohort

Honolulu, September 2026

Published in Epilepsy Research, Volume 228, 2026.

A new study from researchers at Hawaii Pacific Neuroscience (HPN) and the University of Hawai‘i John A. Burns School of Medicine has been published in the journal Epilepsy Research. The study, “Epilepsy-Associated Labor Force Exclusion in a Multi-Ethnic Neurology Cohort,” examines how epilepsy affects employment among Native Hawaiian and Pacific Islander, Asian, and White patients in Hawaii, and what can be done to close the gap.

Why Employment Matters in Epilepsy Care

Having a job is about more than a paycheck. Employment is closely tied to independence, quality of life, and financial stability. For people living with epilepsy, finding and keeping work can be especially difficult. Unpredictable seizures, driving restrictions, worries about disclosing the condition, stigma, and co-occurring mental health conditions can all stand in the way.

While these barriers are well recognized, few studies have measured employment outcomes in epilepsy by comparing patients against other neurology patients seen at the same practice. This study was designed to do exactly that.

About the Study

The research team conducted a retrospective cross-sectional review of adults evaluated at Hawaii Pacific Neuroscience between January 2019 and July 2020. The cohort included Native Hawaiian and Pacific Islander (NHPI), Asian, and White patients whose employment status was documented in their records.

The researchers defined labor force exclusion as being either unemployed or disabled. They compared the groups and used Firth penalized logistic regression to identify which clinical and demographic factors were linked to being left out of the workforce.

Key Findings

Patients with epilepsy were considerably less likely to be employed than other neurology patients at the same practice, and about twice as likely to be unemployed or disabled.

Both differences were statistically significant (p < 0.001).

A Similar Gap Across Ethnic Groups

The employment disadvantage linked to epilepsy was remarkably consistent across all three groups studied. Compared with non-epilepsy neurology patients of the same background, epilepsy patients had lower employment by:

NHPI patients with epilepsy had the highest rate of labor force exclusion at 51.4%. However, once other factors were taken into account, race and ethnicity on their own were not independently associated with being excluded from the workforce.

Factors Linked to Labor Force Exclusion

Across the full cohort, four factors were independently associated with being unemployed or disabled:

• An epilepsy diagnosis
• A psychiatric diagnosis
• Current smoking
• Younger age

What This Means for Patients and Communities

The findings show that epilepsy carries a substantial employment disadvantage, even when compared with other patients receiving neurological care at the same practice. The authors conclude that efforts to improve employment for people with epilepsy should go beyond a single focus and address several areas together:

Seizure control, so patients can work with greater confidence and safety.

Psychiatric comorbidity, through integrated mental health support.

Smoking, as a modifiable risk factor.

Broader structural factors affecting Native Hawaiian and Pacific Islander populations.

At HPN, patients with epilepsy receive care through the Comprehensive Epilepsy Center and the nationally certified Video-EEG Epilepsy Monitoring Unit. Research like this helps shape care that looks at the whole person, including their ability to work and live independently.

Meet the Research Team

The study was carried out by researchers from HPN’s Comprehensive Epilepsy Center, Video-EEG Epilepsy Monitoring Unit, and the BRAIN (Bridging Research and Innovation in Neuroscience) Program, together with the University of Hawai‘i John A. Burns School of Medicine.

Seth Heller

Hawaii Pacific Neuroscience

Jennifer McQueeny

Hawaii Pacific Neuroscience

Darren Dugas

Hawaii Pacific Neuroscience; UH JABSOM

Kore Kai Liow, MD, FAAN

Hawaii Pacific Neuroscience; UH JABSOM

Enrique Carrazana, MD, FAES

Hawaii Pacific Neuroscience; UH JABSOM

Citation: Seth Heller, Jennifer McQueeny, Darren Dugas, Kore Kai Liow, Enrique Carrazana. Epilepsy-associated labor force exclusion in a multi-ethnic neurology cohort. Epilepsy Research, Volume 228, 2026, 107920. ISSN 0920-1211. https://doi.org/10.1016/j.eplepsyres.2026.107920