Racial Disparities in the Surgical Management of Intractable Temporal Lobe Epilepsy in the United States

Abstract

To determine whether, over a long time span, race and/or other predictive factors for patients with intractable temporal lobe epilepsy (TLE) who receive anterior temporal lobectomy (ATL) exist on a national level.

Epilepsy surgery trends in the United States, 1990–2008

“…We found that racial minorities were significantly less likely to receive surgical treatment than white individuals, and patients with Medicare or Medicaid had surgery at notably lower rates than those with private insurance. Previous studies have also found similar inequalities in the epilepsy surgery, noting in particular underutilization among black patients, 14,37 as well as significant treatment disparities by socioeconomic status. 14,38,39 While the reasons for this disparity are not fully understood, we did observe that white patients were more likely to have private insurance than nonwhite individuals.…”

“…Previous studies have also found similar inequalities in the epilepsy surgery, noting in particular underutilization among black patients, 14,37 as well as significant treatment disparities by socioeconomic status. 14,38,39 While the reasons for this disparity are not fully understood, we did observe that white patients were more likely to have private insurance than nonwhite individuals. Therefore, it is possible that lower rate of surgery among racial minorities is influenced by access to care or financial considerations of treating institutions.…”

“…These diagnosis and procedure codes have been utilized in other NIS-based studies of lobectomy for epilepsy. 14,15 The total number of hospitalizations for intractable localized epilepsy, lobectomy procedures, and the percentage of intractable localized epilepsy patients receiving lobectomy were plotted annually from 1990 to 2008, and were also measured for each individual hospital in the database. Hospital-level data during 1990 -1994 and 2004 -2008 were stratified by hospital caseload of lobectomy for epilepsy to compare the 20 hospitals performing the most procedures to all other hospitals performing the procedure.…”

Time to pediatric epilepsy surgery is related to disease severity and nonclinical factors

“…Although studies have demonstrated sociodemographic disparities in the utilization of temporal lobectomy, none have examined whether such factors mediate delays in time to surgery in children. [14][15][16][17] To elucidate factors associated with timing of referral and surgery among children with epilepsy, we utilized a large cohort from the University of California, Los Angeles (UCLA) who had surgery over the past 25 years. Based on prior literature in children and adults, we hypothesized that increased epilepsy severity as documented by a history of IS and a greater seizure frequency, abnormal pre-referral brain MRI, private insurance, and non-Hispanic, white race/ethnicity would be associated with shorter time to surgery.…”

Quality improvement in neurology: AAN epilepsy quality measures

“…4 There are racial, ethnic, and socioeconomic disparities in access to treatment, especially surgery. 5 A lack of specialty care may lead to delayed recognition of seizures and inadequate treatment. 6 Thus, there is a large disparity between care that should be delivered and the care that is actually delivered.…”