Effect of Race and Insurance Type on Access to, and Outcomes of, Epilepsy Surgery: A Literature Review.

Autor: Howard SD; Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: Susanna.howard@pennmedicine.upenn.edu., Campbell PA; Department of Surgery, University of California San Francisco, San Francisco, California, USA., Montgomery CT; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Tomlinson SB; Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Ojukwu DI; Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Chen HI; Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA., Chin MH; Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2023 Oct; Vol. 178, pp. 202-212.e2. Date of Electronic Publication: 2023 Aug 04.
DOI: 10.1016/j.wneu.2023.07.138
Abstrakt: Background: Despite higher rates of seizure freedom, a large proportion of patients with medically refractory seizures who could benefit from epilepsy surgery do not receive surgical treatment. This literature review describes the association of race and insurance status with epilepsy surgery access and outcomes.
Methods: Searches in Scopus and PubMed databases related to disparities in epilepsy surgery were conducted. The inclusion criteria consisted of data that could be used to compare epilepsy surgery patient access and outcomes by insurance or race in the United States. Two independent reviewers determined article eligibility.
Results: Of the 289 studies reviewed, 26 were included. Most of the studies were retrospective cohort studies (23 of 26) and national admissions database studies (13 of 26). Of the 17 studies that evaluated epilepsy surgery patient demographics, 11 showed that Black patients were less likely to receive surgery than were White patients or had an increased time to surgery from seizure onset. Nine studies showed that patients with private insurance were more likely to undergo epilepsy surgery and have shorter time to surgery compared with patients with public insurance. No significant association was found between the seizure recurrence rate after surgery with insurance or race.
Conclusions: Black patients and patients with public insurance are receiving epilepsy surgery at lower rates after a prolonged waiting period compared with other patients with medically refractory epilepsy. These results are consistent across the current reported literature. Future efforts should focus on additional characterization and potential causes of these disparities to develop successful interventions.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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