Racial and socioeconomic disparities in the advanced treatment of medically intractable pediatric epilepsy

Abstract

OBJECTIVE Racial and ethnic disparities in healthcare have gained significant importance since the Institute of Medicine published its report on disparities in healthcare. There is a lack of evidence on how race and ethnicity affect access to advanced treatment of pediatric medically intractable epilepsy. In this context, the authors analyzed the latest Kids’ Inpatient Database (KID) for racial/ethnic disparities in access to surgical treatment of epilepsy. METHODS The authors queried the KID for the years 2016 and 2019 for the diagnosis of medically intractable epilepsy. RESULTS A total of 29,292 patients were included in the sample. Of these patients, 8.9% (n = 2610) underwent surgical treatment/invasive monitoring. The mean ages in the surgical treatment and nonsurgical treatment groups were 11.73 years (SD 5.75 years) and 9.5 years (SD 6.16 years), respectively. The most common insurance in the surgical group was private/commercial (55.9%) and Medicaid in the nonsurgical group (47.7%) (p < 0.001). White patients accounted for the most common population in both groups, followed by Hispanic patients. African American patients made up 7.9% in the surgical treatment group compared with 12.9% in the nonsurgical group. African American (41.1%) and Hispanic (29.9%) patients had higher rates of emergency department (ED) utilization compared with the White population (24.6%). After adjusting for all covariates, the odds of surgical treatment increased with increasing age (OR 1.06, 95% CI 1.053–1.067; p < 0.001). African American race (OR 0.513, 95% CI 0.443–0.605; p < 0.001), Hispanic ethnicity (OR 0.681, 95% CI 0.612–0.758; p < 0.001), and other races (OR 0.789, 95% CI 0.689–0.903; p = 0.006) had lower surgical treatment odds compared with the White population. Medicaid/Medicare was associated with lower surgical treatment odds than private/commercial insurance (OR 0.603, 0.554–0.657; p < 0.001). Interaction analysis revealed that African American (OR 0.708, 95% CI 0.569–0.880; p = 0.001) and Hispanic (OR 0.671, 95% CI 0.556–0.809; p < 0.001) populations with private insurance had lower surgical treatment odds than White populations with private insurance. Similarly, African American patients, Hispanic patients, and patients of other races with nonprivate insurance also had lower surgical treatment odds than their White counterparts after adjusting for all other covariates. CONCLUSIONS Based on the KID, African American and Hispanic populations had lower surgical treatment rates than their White counterparts, with higher utilization of the ED for pediatric medically intractable epilepsy.

Computer-assisted analysis of routine EEG to identify hidden biomarkers of epilepsy: A systematic review

“…Another and even more important caveat is the risk of increasing social and racial disparities that are well documented in epilepsy. [125] , [126] , [127] By training on data that contain these bias, researchers must take active steps to identify and correct for these inequities. [128] , [129] Simulation studies could help quantify the net clinical benefits and provide an accurate cost-benefits estimate, [130] which will ultimately hinge on the diagnostic performances of the algorithms.…”

Deep brain stimulation and intrathecal/intraventricular baclofen for glutaric aciduria type 1: A scoping review, individual patient data analysis, and clinical trials review

“…The financial implications impacts the access to these treatments. Studies have documented disparities in access to neurosurgical treatments in other patient populations 57,58 …”

“…Studies have documented disparities in access to neurosurgical treatments in other patient populations. 57,58 Extrapolating existing cost-effectiveness studies focused on these treatment modalities may be required, as cost-effectiveness analyses specific to GA1 are lacking. Newborn screening for GA1 is cost-effective.…”

Health inequities and socioeconomic factors predicting the access to treatment for unruptured intracranial aneurysms in the USA in the last 20 years: interaction effect of race, gender, and insurance

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