1
|
Bagayoko T, Houot M, Navarro V, Herlin B, Dupont S. Discriminating factors in access to video-EEG for epilepsy surgery in a French tertiary epilepsy center. Rev Neurol (Paris) 2024; 180:770-776. [PMID: 38806360 DOI: 10.1016/j.neurol.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/26/2024] [Accepted: 04/06/2024] [Indexed: 05/30/2024]
Abstract
Equitable access to care and management is a priority for patients with epilepsy and may vary depending on each country's healthcare system. As this issue has not been specifically addressed in France, we conducted a retrospective study to identify discriminating factors in access to surgery at a French tertiary epilepsy center. Initially, we examined factors previously identified in other countries as influential in surgery access, including age at diagnosis, affected side, gender, years of education, socio-professional categories, and density of general practitioners in the residential area, in 293 consecutive French-native patients with refractory medial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS). Subsequently, we conducted a case-control study comparing patients born in France with 22 patients born abroad to specifically explore migratory status. The analysis revealed that the only three factors statistically influencing the delay between the onset of epilepsy and entry into video-EEG were early age at onset (associated with a longer delay), pensioner status (associated with a longer delay), and student status (associated with a shorter delay). Migratory status, gender, and socio-economic level (indirectly reflected by the level of education and socio-professional category) were not found to be discriminatory factors in access to video-EEG. Discrepancies between our study and foreign studies may be attributed to differences in healthcare systems and medical coverage among countries. Efforts in France to improve access to surgery should focus on enhancing communication among practitioners to promptly refer any MTLE-HS patient to an epilepsy surgery center, regardless of their age.
Collapse
Affiliation(s)
- T Bagayoko
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - M Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital Paris, Paris, France
| | - V Navarro
- AP-HP, Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France; Paris Brain Institute (ICM), Inserm, CNRS, Pitié-Salpêtrière Hospital Paris, Paris, France
| | - B Herlin
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - S Dupont
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; AP-HP, Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France; Paris Brain Institute (ICM), Inserm, CNRS, Pitié-Salpêtrière Hospital Paris, Paris, France.
| |
Collapse
|
2
|
Ruiz Colón GD, Barros Guinle MI, Wu A, Grant GA, Prolo LM. Neurosurgical Outcomes Among Non-English Speakers: A Systematic Review and a Framework for Future Research. World Neurosurg 2024; 185:338-350.e1. [PMID: 38387790 DOI: 10.1016/j.wneu.2024.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE In 2019, 22% of adults in the United States reported speaking a language other than English at home, representing 52% growth since 2000. This diversity in languages - and resulting possible communication barriers - represents a potential challenge to effective care. In this manuscript, we summarize clinical outcomes and healthcare utilization patterns of adult and pediatric neurosurgical patients who are non-English primary language speakers (NEPLS). METHODS We systematically queried 5 databases from inception through October 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify studies for inclusion. The Newcastle-Ottawa Scale was used to assess the quality of studies. Additionally, a retrospective chart review was conducted to assess differences in postoperative communication patterns in a cohort of English and Spanish speaking patients with craniosynostosis at our institution. RESULTS Our search yielded 442 abstracts; ten were included in the final cohort. Outcomes for 973 unique NEPLS with a neurosurgical condition were included; Spanish was the most represented language. Delivery and timing of surgical treatment was the most frequently reported metric; 75% of studies demonstrated a statistically significant delay in time to surgery or decreased likelihood for NEPLS to receive surgical treatment. Length of stay was reported in 3 studies; all demonstrated that NEPLS had longer length of stay. CONCLUSIONS There is a paucity of literature reporting outcomes among NEPLS. It is critical to examine NEPLS patients' outcomes and experiences, as language barriers are potentially modifiable demographic factors. We present a framework that demonstrates opportunities for further research to improve quality of care.
Collapse
Affiliation(s)
- Gabriela D Ruiz Colón
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | | | - Adela Wu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura M Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California, USA.
| |
Collapse
|
3
|
Campbell JM, Yost S, Gautam D, Herich A, Botros D, Slaughter M, Chodakiewitz M, Arain A, Peters A, Richards S, Newman B, Johnson B, Rahimpour S, Shofty B. Delays in the diagnosis and surgical treatment of drug-resistant epilepsy: A cohort study. Epilepsia 2024; 65:1314-1321. [PMID: 38456604 PMCID: PMC11087196 DOI: 10.1111/epi.17944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Delay in referral for epilepsy surgery of patients with drug-resistant epilepsy (DRE) is associated with decreased quality of life, worse surgical outcomes, and increased risk of sudden unexplained death in epilepsy (SUDEP). Understanding the potential causes of delays in referral and treatment is crucial for optimizing the referral and treatment process. We evaluated the treatment intervals, demographics, and clinical characteristics of patients referred for surgical evaluation at our level 4 epilepsy center in the U.S. Intermountain West. METHODS We retrospectively reviewed the records of patients who underwent surgery for DRE between 2012 and 2022. Data collected included patient demographics, DRE diagnosis date, clinical characteristics, insurance status, distance from epilepsy center, date of surgical evaluation, surgical procedure, and intervals between different stages of evaluation. RESULTS Within our cohort of 185 patients with epilepsy (99 female, 53.5%), the mean ± standard deviation (SD) age at surgery was 38.4 ± 11.9 years. In this cohort, 95.7% of patients had received definitive epilepsy surgery (most frequently neuromodulation procedures) and 4.3% had participated in phase 2 intracranial monitoring but had not yet received definitive surgery. The median (1st-3rd quartile) intervals observed were 10.1 (3.8-21.5) years from epilepsy diagnosis to DRE diagnosis, 16.7 (6.5-28.4) years from epilepsy diagnosis to surgery, and 1.4 (0.6-4.0) years from DRE diagnosis to surgery. We observed significantly shorter median times from epilepsy diagnosis to DRE diagnosis (p < .01) and epilepsy diagnosis to surgery (p < .05) in patients who traveled further for treatment. Patients with public health insurance had a significantly longer time from DRE diagnosis to surgery (p < .001). SIGNIFICANCE Both shorter distance traveled to our epilepsy center and public health insurance were predictive of delays in diagnosis and treatment intervals. Timely referral of patients with DRE to specialized epilepsy centers for surgery evaluation is crucial, and identifying key factors that may delay referral is paramount to optimizing surgical outcomes.
Collapse
Affiliation(s)
- Justin M. Campbell
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, Utah, USA
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Samantha Yost
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Diwas Gautam
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alysha Herich
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - David Botros
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Mason Slaughter
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Michael Chodakiewitz
- Department of Neurosurgery, University of California, Los Angeles, California, USA
- Department of Surgery, Zucker School of Medicine at Hofstra, Hempstead, New York, USA
- Tel Aviv University, Tel Aviv, Israel
| | - Amir Arain
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Angela Peters
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Sindhu Richards
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Blake Newman
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Brian Johnson
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben Shofty
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah Health, Salt Lake City, Utah, USA
| |
Collapse
|
4
|
Miller JS, Oladele F, McAfee D, Adereti CO, Theodore WH, Akinsoji EO. Disparities in Epilepsy Diagnosis and Management in High-Income Countries: A Review of the Literature. Neurol Clin Pract 2024; 14:e200259. [PMID: 38585438 PMCID: PMC10996906 DOI: 10.1212/cpj.0000000000200259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/20/2023] [Indexed: 04/09/2024]
Abstract
Purpose of Review Currently, an estimated 3.4 million people in the United States live with epilepsy. Previous studies have identified health disparities associated with race/ethnicity, socioeconomic status (SES), sex, insurance status, and age in this population. However, there has been a dearth of research addressing these disparities. We performed a literature review of articles published between 2010 and 2020 pertaining to health disparities in people with epilepsy (PWE), identified key factors that contribute to gaps in their care, and discussed possible solutions. Recent Findings Health disparities in prevalence, treatment access, time to diagnosis, health care delivery and engagement, and clinical outcomes were identified among individuals who were either of low SES, rural-based, uninsured/underinsured, older patients, patients of color, or female sex. Summary Disparities in care for PWE continue to persist. Greater priority should be placed on addressing these gaps intricately tied to sociodemographic factors. Reforms to mitigate health disparities in PWE are necessary for timely diagnosis, effective treatment, and positive long-term outcomes.
Collapse
Affiliation(s)
- Joseph S Miller
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - Folake Oladele
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - Darrian McAfee
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - Christopher O Adereti
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - William H Theodore
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| | - Elizabeth O Akinsoji
- Ohio University Heritage College of Osteopathic Medicine (JSM), Dublin, OH; Memorial Sloan Kettering Cancer Center (FO), New York; University of Maryland School of Medicine (DM), Baltimore, MD; Ross University School of Medicine (COA); National Institute of Neurological Disorders and Stroke (WHT), National Institutes of Health, Bethesda, MD; and Department of Neurology (EOA), Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
5
|
Abath CB, Gupta N, Hadjinicolaou A, Donatelli S, Singh A, Merchant S, Ryan ME, Soby M, Ryan C, Nelson AK, Maldonado Pacheco JE, Zhang B, Williams DN, Yuskaitis CJ, Harini C. Delays to care in infantile epileptic spasms syndrome: Racial and ethnic inequities. Epilepsia 2024; 65:107-114. [PMID: 37953072 DOI: 10.1111/epi.17827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Non-Hispanic (NH) Black children are less likely to receive a standard treatment course for infantile epileptic spasms syndrome (IESS) than White/NH children at pediatric tertiary care epilepsy centers in the United States. However, if inequities exist in time to diagnosis is unknown. Diagnostic delays as little as 1 week can be associated with worse developmental outcomes. METHODS Diagnostic delays were evaluated in a retrospective cohort of 100 children with new onset IESS between January 2019 and May 2022. RESULTS Children with Black, Indigenous, and People of Color (BIPOC) caregivers were more likely to experience clinically significant delays in referral from first provider to neurologist, when compared to White/NH children, even after controlling for other demographic and clinical variables (odds ratio = 4.98, confidence interval = 1.24-19.94, p = .023). SIGNIFICANCE Disproportionate diagnostic delays place BIPOC children at risk of adverse developmental and epilepsy outcomes. Further interventional prospective and qualitative studies are needed to address inequities in care.
Collapse
Affiliation(s)
- Christina Briscoe Abath
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nishtha Gupta
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Stephanie Donatelli
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Avantika Singh
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabrina Merchant
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Morgan E Ryan
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meghann Soby
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christopher Ryan
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adrianne Katrina Nelson
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - John E Maldonado Pacheco
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Bo Zhang
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - David N Williams
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christopher J Yuskaitis
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Chellamani Harini
- Department of Neurology, Comprehensive Epilepsy Program, Division of Epilepsy, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Kerr WT, McFarlane KN. Machine Learning and Artificial Intelligence Applications to Epilepsy: a Review for the Practicing Epileptologist. Curr Neurol Neurosci Rep 2023; 23:869-879. [PMID: 38060133 DOI: 10.1007/s11910-023-01318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW Machine Learning (ML) and Artificial Intelligence (AI) are data-driven techniques to translate raw data into applicable and interpretable insights that can assist in clinical decision making. Some of these tools have extremely promising initial results, earning both great excitement and creating hype. This non-technical article reviews recent developments in ML/AI in epilepsy to assist the current practicing epileptologist in understanding both the benefits and limitations of integrating ML/AI tools into their clinical practice. RECENT FINDINGS ML/AI tools have been developed to assist clinicians in almost every clinical decision including (1) predicting future epilepsy in people at risk, (2) detecting and monitoring for seizures, (3) differentiating epilepsy from mimics, (4) using data to improve neuroanatomic localization and lateralization, and (5) tracking and predicting response to medical and surgical treatments. We also discuss practical, ethical, and equity considerations in the development and application of ML/AI tools including chatbots based on Large Language Models (e.g., ChatGPT). ML/AI tools will change how clinical medicine is practiced, but, with rare exceptions, the transferability to other centers, effectiveness, and safety of these approaches have not yet been established rigorously. In the future, ML/AI will not replace epileptologists, but epileptologists with ML/AI will replace epileptologists without ML/AI.
Collapse
Affiliation(s)
- Wesley T Kerr
- Department of Neurology, University of Pittsburgh, 3471 Fifth Ave, Kaufmann 811.22, Pittsburgh, PA, 15213, USA.
- Department of Biomedical Informatics, University of Pittsburgh, 3471 Fifth Ave, Kaufmann 811.22, Pittsburgh, PA, 15213, USA.
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Katherine N McFarlane
- Department of Neurology, University of Pittsburgh, 3471 Fifth Ave, Kaufmann 811.22, Pittsburgh, PA, 15213, USA
| |
Collapse
|
7
|
Pellinen J, Pardoe H, Sillau S, Barnard S, French J, Knowlton R, Lowenstein D, Cascino GD, Glynn S, Jackson G, Szaflarski J, Morrison C, Meador KJ, Kuzniecky R. Later onset focal epilepsy with roots in childhood: Evidence from early learning difficulty and brain volumes in the Human Epilepsy Project. Epilepsia 2023; 64:2761-2770. [PMID: 37517050 DOI: 10.1111/epi.17727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Visual assessment of magnetic resonance imaging (MRI) from the Human Epilepsy Project 1 (HEP1) found 18% of participants had atrophic brain changes relative to age without known etiology. Here, we identify the underlying factors related to brain volume differences in people with focal epilepsy enrolled in HEP1. METHODS Enrollment data for participants with complete records and brain MRIs were analyzed, including 391 participants aged 12-60 years. HEP1 excluded developmental or cognitive delay with intelligence quotient <70, and participants reported any formal learning disability diagnoses, repeated grades, and remediation. Prediagnostic seizures were quantified by semiology, frequency, and duration. T1-weighted brain MRIs were analyzed using Sequence Adaptive Multimodal Segmentation (FreeSurfer v7.2), from which a brain tissue volume to intracranial volume ratio was derived and compared to clinically relevant participant characteristics. RESULTS Brain tissue volume changes observable on visual analyses were quantified, and a brain tissue volume to intracranial volume ratio was derived to compare with clinically relevant variables. Learning difficulties were associated with decreased brain tissue volume to intracranial volume, with a ratio reduction of .005 for each learning difficulty reported (95% confidence interval [CI] = -.007 to -.002, p = .0003). Each 10-year increase in age at MRI was associated with a ratio reduction of .006 (95% CI = -.007 to -.005, p < .0001). For male participants, the ratio was .011 less than for female participants (95% CI = -.014 to -.007, p < .0001). There were no effects from seizures, employment, education, seizure semiology, or temporal lobe electroencephalographic abnormalities. SIGNIFICANCE This study shows lower brain tissue volume to intracranial volume in people with newly treated focal epilepsy and learning difficulties, suggesting developmental factors are an important marker of brain pathology related to neuroanatomical changes in focal epilepsy. Like the general population, there were also independent associations between brain volume, age, and sex in the study population.
Collapse
Affiliation(s)
- Jacob Pellinen
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Heath Pardoe
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Stefan Sillau
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Jacqueline French
- New York University Comprehensive Epilepsy Center, New York, New York, USA
| | - Robert Knowlton
- University of California, San Francisco, San Francisco, California, USA
| | - Daniel Lowenstein
- University of California, San Francisco, San Francisco, California, USA
| | | | - Simon Glynn
- University of Michigan, Ann Arbor, Michigan, USA
| | - Graeme Jackson
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | | | - Chris Morrison
- New York University Comprehensive Epilepsy Center, New York, New York, USA
| | - Kimford J Meador
- Stanford University Neuroscience Health Center, Palo Alto, California, USA
| | | |
Collapse
|
8
|
Shah P, Skjei K. Health Disparities for Immigrant Children: Focus on Epilepsy. Pediatr Ann 2023; 52:e373-e380. [PMID: 37820703 DOI: 10.3928/19382359-20230829-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Although health and health care disparities between immigrant and native-born adult populations in the United States are well documented, the pediatric literature is limited. Data suggest first- and second- generation immigrant children have worse health outcomes when compared with their native-born counterparts because of factors such as socioeconomic status, insurance and language barriers, authorization status, and bias/xenophobia. This article takes a broad look at existing research regarding health barriers for immigrant children, then focuses on the pediatric epilepsy literature to highlight the complex interplay of these disparity factors. Finally, we review the literature on existing interventions, including language concordance, community-driven educational efforts, and broad-scale policy changes that can be used to promote health equity in pediatric epilepsy and beyond. Research gaps are also identified. [Pediatr Ann. 2023;52(10):e373-e380.].
Collapse
|
9
|
Howard SD, Campbell PA, Montgomery CT, Tomlinson SB, Ojukwu DI, Chen HI, Chin MH. Effect of Race and Insurance Type on Access to, and Outcomes of, Epilepsy Surgery: A Literature Review. World Neurosurg 2023; 178:202-212.e2. [PMID: 37543199 DOI: 10.1016/j.wneu.2023.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- Susanna D Howard
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Paige-Ashley Campbell
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Canada T Montgomery
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuel B Tomlinson
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Disep I Ojukwu
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - H Isaac Chen
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Marshall H Chin
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
10
|
Health Disparities in Pediatric Epilepsy: Methods and Lessons Learned. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09898-1. [PMID: 35930105 PMCID: PMC9362655 DOI: 10.1007/s10880-022-09898-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2022] [Indexed: 11/09/2022]
Abstract
Epilepsy affects 1% of youth and is associated with neurocognitive and psychosocial comorbidities, increased risk of mortality, and poor health-related outcomes. Health disparities in children and youth with epilepsy (CYE) have been understudied. A Special Interest Group (SIG) within the Pediatric Epilepsy Research Consortium is conducting a scoping review to systematically assess the literature and highlight the gaps in access to clinical care and management of pediatric epilepsy. The methodology for this review is presented. In conducting a peer-reviewed assessment of the scope of health disparities in pediatric epilepsy, we learned that developing the methodology for and conducting a comprehensive scoping review with multiple contributors resulted in a time-intensive process. While there is an evidence to suggest that health disparities do exist in CYE, very few studies have focused on these disparities. Disparity results are often not included in key elements of articles, lending them to be underemphasized and underrecognized. Preliminary conclusions inform several important research considerations.
Collapse
|
11
|
Baumer FM, Mytinger JR, Neville K, Briscoe Abath C, Gutierrez CA, Numis AL, Harini C, He Z, Hussain SA, Berg AT, Chu CJ, Gaillard WD, Loddenkemper T, Pasupuleti A, Samanata D, Singh RK, Singhal NS, Wusthoff CJ, Wirrell EC, Yozawitz E, Knupp KG, Shellhaas RA, Grinspan ZM. Inequities in therapy for infantile spasms: a call to action. Ann Neurol 2022; 92:32-44. [PMID: 35388521 DOI: 10.1002/ana.26363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/22/2022] [Accepted: 03/15/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether selection of treatment for children with infantile spasms (IS) varies by race/ethnicity. METHODS The prospective US National Infantile Spasms Consortium database includes children with IS treated from 2012-2018. We examined the relationship between race/ethnicity and receipt of standard IS therapy (prednisolone, adrenocorticotropic hormone, vigabatrin), adjusting for demographic and clinical variables using logistic regression. Our primary outcome was treatment course, which considered therapy prescribed for the first and, when needed, the second IS treatment together. RESULTS Of 555 children, 324 (58%) were Non-Hispanic white, 55 (10%) Non-Hispanic Black, 24 (4%) Non-Hispanic Asian, 80 (14%) Hispanic, and 72 (13%) Other/Unknown. Most (398, 72%) received a standard treatment course. Insurance type, geographic location, history of prematurity, prior seizures, developmental delay or regression, abnormal head circumference, hypsarrhythmia, and IS etiologies were associated with standard therapy. In adjusted models, Non-Hispanic Black children had lower odds of receiving a standard treatment course compared with Non-Hispanic white children (OR 0.42, 95% CI 0.20-0.89, p = 0.02). Adjusted models also showed that children with public (vs. private) insurance had lower odds of receiving standard therapy for treatment 1 (OR 0.42, CI 0.21-0.84, p = 0.01). INTERPRETATION Non-Hispanic Black children were more often treated with non-standard IS therapies than Non-Hispanic white children. Likewise, children with public (vs. private) insurance were less likely to receive standard therapies. Investigating drivers of inequities, and understanding the impact of racism on treatment decisions, are critical next steps to improve care for patients with IS. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Kerri Neville
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan (Michigan Medicine), Ann Arbor, MI
| | - Christina Briscoe Abath
- Department of Child Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Camilo A Gutierrez
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD
| | - Adam L Numis
- Department of Neurology, Division of Epilepsy, University of California San Francisco, San Francisco, CA
| | - Chellamani Harini
- Department of Child Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Zihuai He
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Shaun A Hussain
- Department of Pediatrics, Division of Pediatric Neurology, University of California, Los Angeles, CA
| | - Anne T Berg
- Ann & Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Catherine J Chu
- Department of Neurology, Divisions of Child Neurology and Neurophysiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Tobias Loddenkemper
- Department of Child Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Debopam Samanata
- Division of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, AR
| | - Rani K Singh
- Department of Pediatrics, Atrium Health-Levine Children's, Charlotte, NC
| | - Nilika S Singhal
- Department of Neurology, Division of Epilepsy, University of California San Francisco, San Francisco, CA
| | - Courtney J Wusthoff
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Elaine C Wirrell
- Department of Neurology, Divisions of Epilepsy and Child and Adolescent Neurology, Mayo Clinic, Rochester, MN
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology and Department of Pediatrics, Montefiore Medical Center, NY
| | - Kelly G Knupp
- Department of Pediatrics, New York-Presbyterian Komansky Children's Hospital, Weill Cornell Medicine, New York, NY
| | - Renée A Shellhaas
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan (Michigan Medicine), Ann Arbor, MI
| | - Zachary M Grinspan
- Department of Pediatrics and Neurology, University of Colorado, Aurora, CO.,Department of Healthcare Policy & Research, New York-Presbyterian Komansky Children's Hospital, Weill Cornell Medicine, New York, NY
| | | |
Collapse
|
12
|
Underrepresented Populations in Pediatric Epilepsy Surgery. Semin Pediatr Neurol 2021; 39:100916. [PMID: 34620462 DOI: 10.1016/j.spen.2021.100916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
As awareness of pediatric epilepsy increases, accompanied by advancements in technology and research, it is important to identify certain types of patients that are overlooked for surgical management of epilepsy. Identifying these populations will allow us to study and elucidate the factors contributing to the underutilization and/or delayed application of surgical interventions. Demographically, African-American and Hispanic patients, as well as patients of certain Asian ethnicities, have relatively lower rates of undergoing epilepsy surgery than non-Hispanic and white patients. Among patients with epilepsy, those with higher odds of seizure-freedom following surgery are more likely to be referred for surgical evaluation by their neurologists, with the most common diagnosis being lesional focal epilepsy. However, patients with multifocal or generalized epilepsy, genetic etiologies, or normal (non-lesional) brain magnetic resonance imaging (MRI) are less likely be to referred for evaluation for resective surgery. With an increasing number of high-quality imaging modalities to help localize the epileptogenic zone as well as new techniques for both curative and palliative epilepsy surgery, there are very few populations of patients and/or types of epilepsy that should be precluded from evaluation to determine the suitability of epilepsy surgery. Ultimately, a clearer understanding of the populations who are underrepresented among those considered for epilepsy surgery, coupled with further study of the underlying reasons for this trend, will lead to less disparity in access to this critical treatment among patients with epilepsy.
Collapse
|
13
|
Pellinen J, Tafuro E, Yang A, Price D, Friedman D, Holmes M, Barnard S, Detyniecki K, Hegde M, Hixson J, Haut S, Kälviäinen R, French J. Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy. Epilepsia 2020; 61:2643-2652. [DOI: 10.1111/epi.16707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Jacob Pellinen
- Department of Neurology New York University Grossman School of Medicine and NYU Langone Health New York NY USA
| | | | - Annie Yang
- Department of Neurology Yale University School of Medicine New Haven CT USA
| | - Dana Price
- Department of Neurology New York University Grossman School of Medicine and NYU Langone Health New York NY USA
| | - Daniel Friedman
- Department of Neurology New York University Grossman School of Medicine and NYU Langone Health New York NY USA
| | - Manisha Holmes
- Department of Neurology New York University Grossman School of Medicine and NYU Langone Health New York NY USA
| | - Sarah Barnard
- Monash University School of Medicine Clayton Victoria Australia
| | - Kamil Detyniecki
- Department of Neurology University of Miami Miller School of Medicine Miami FL USA
| | - Manu Hegde
- Department of Neurology University of California, San Francisco School of Medicine San Francisco CA USA
| | - John Hixson
- Department of Neurology University of California, San Francisco School of Medicine San Francisco CA USA
| | - Sheryl Haut
- Department of Neurology Albert Einstein College of Medicine Bronx NY USA
| | - Reetta Kälviäinen
- Institute of Clinical Medicine Kuopio University Hospital and University of Eastern Finland Kuopio Finland
| | - Jacqueline French
- Department of Neurology New York University Grossman School of Medicine and NYU Langone Health New York NY USA
| | | |
Collapse
|
14
|
Allen SE, Limdi NA, Westrick AC, Ver Hoef LW, Szaflarski JP, Kuzniecky RI, Knowlton RC. Racial differences in adult-onset MRI-negative temporal lobe epilepsy. Epilepsy Behav 2019; 100:106501. [PMID: 31574425 DOI: 10.1016/j.yebeh.2019.106501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/06/2019] [Accepted: 08/14/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We recently detected a significant racial difference in our population with temporal lobe epilepsy (TLE) at the University of Alabama at Birmingham (UAB) seizure monitoring unit. We found that Black patients were more likely than their White counterparts to carry a TLE diagnosis. Using this same patient population, we focus on the patients with TLE to better describe the relationship between race and epidemiology in this population. METHODS We analyzed the data from patients diagnosed with TLE admitted to the UAB seizure monitoring unit between January 2000 and December 2011. For patients with a video electroencephalography (EEG) confirmed diagnosis of TLE (n = 385), basic demographic information including race and magnetic resonance imaging (MRI) findings were collected. Descriptive statistics and multivariate logistic regression were used to explore the relationship between MRI findings, demographic data, and race. RESULTS For Black patients with TLE, we found that they were more likely to be female (odds ratio [OR] = 1.91, 95% confidence interval [CI]: 1.14-3.19), have seizure onset in adulthood (OR = 2.39, 95% CI: 1.43-3.19), and have normal MRIs (OR = 1.69, 95% CI: 1.04-2.77) compared to White counterparts with TLE after adjusting for covariates. CONCLUSIONS These data suggest that Black race (compared to White) is associated with higher expression of adult-onset MRI-negative TLE, an important subtype of epilepsy with unique implications for evaluation, treatment, and prognosis. If validated in other cohorts, the findings may explain the lower reported rates of epilepsy surgery utilization among Blacks. The racial differences in surgical utilization could be due to a greater prevalence of an epilepsy that is less amenable to surgical resection rather than to cultural differences or access to care.
Collapse
Affiliation(s)
- Samantha E Allen
- University of Oregon Health and Science, Department of Neurology, United States of America
| | - Nita A Limdi
- University of Alabama Birmingham, Department of Neurology, United States of America
| | - Ashly C Westrick
- University of Miami, Department of Public Health Sciences, United States of America
| | - Lawrence W Ver Hoef
- University of Alabama Birmingham, Department of Neurology, United States of America
| | - Jerzy P Szaflarski
- University of Alabama Birmingham, Department of Neurology, United States of America
| | - Ruben I Kuzniecky
- Northwell Health Physician Partners Neurology at Lenox Hill, United States of America
| | - Robert C Knowlton
- University of California San Francisco, Department of Neurology, United States of America.
| |
Collapse
|
15
|
Nathan CL, Gutierrez C. FACETS of health disparities in epilepsy surgery and gaps that need to be addressed. Neurol Clin Pract 2018; 8:340-345. [PMID: 30140586 DOI: 10.1212/cpj.0000000000000490] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/27/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review Disparities in treatment and outcomes of patients with epilepsy have been identified in several distinct patient populations. The purpose of this review is to organize the literature and establish clear pathways as to why certain patient populations are not receiving epilepsy surgery. By establishing the acronym FACETS (fear of treatment, access to care, communication barriers, education, trust between patient and physician, and social support), we set up a pathway to further study this area in an organized fashion, hopefully leading to objective solutions. Recent findings Studies revealed that African American, Hispanic, and non-English-speaking patients underwent surgical treatment for epilepsy at rates significantly lower compared to white patients. Summary This article explains possible reasons outlined by FACETS for the health disparities in epilepsy surgery that exist in patients of a certain race, socioeconomic status, and language proficiency.
Collapse
Affiliation(s)
- Cody L Nathan
- Hospital of the University of Pennsylvania (CLN), Philadelphia; and Department of Neurology (CG), University of Maryland Medical Center, Baltimore
| | - Camilo Gutierrez
- Hospital of the University of Pennsylvania (CLN), Philadelphia; and Department of Neurology (CG), University of Maryland Medical Center, Baltimore
| |
Collapse
|
16
|
Martínez-Juárez IE, Funes B, Moreno-Castellanos JC, Bribiesca-Contreras E, Martínez-Bustos V, Zertuche-Ortuño L, Hernández-Vanegas LE, Ronquillo LH, Rizvi S, Adam W, Tellez-Zenteno JF. A comparison of waiting times for assessment and epilepsy surgery between a Canadian and a Mexican referral center. Epilepsia Open 2017; 2:453-458. [PMID: 29588975 PMCID: PMC5862123 DOI: 10.1002/epi4.12082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 01/03/2023] Open
Abstract
Objective To provide a comprehensive transnational overview of wait times for epilepsy surgery in Canada and Mexico. Methods We reviewed all cases referred for epilepsy surgery between 2007 and 2015 at the Saskatchewan Epilepsy Program Royal University Hospital (SEP) (n = 70; Saskatoon, Canada) and the National Institute of Neurology and Neurosurgery (NINN) (n = 76; Mexico City, Mexico) and compared wait times, calculated as the time from diagnosis of epilepsy on assessment at an epilepsy center to epilepsy surgery. Results Mean wait times were similar across centers. Mean patient age was 37.4 ± 9 years (NINN) and 36.7 ± 13.2 years (SEP). The mean time from epilepsy diagnosis to referral was 18.9 (NINN) and 16.9 years (SEP), p = 0.30; first consult with the epileptologist, 19.7 (NINN) and 17.4 years (p = 0.23); neuropsychology consult, 21.4 (NINN) and 17.9 years (SEP); video electroencephalogram (video-EEG) telemetry, 21.1 (NINN) and 18.6 months (SEP); initial neurosurgical consult, 21.9 (NINN) and 19.1 years (SEP) (p = 0.35); and epilepsy surgery, 19.7 (NINN) and 19.6 years (SEP) (p = 0.29). Significance This is the first study to compare wait times between Canada and Mexico. Despite disparity in their health delivery systems and financial resources, surgical wait times appeared to be protracted in both nations, confirming that delayed treatment is a universal problem that requires collaborative scrutiny.
Collapse
Affiliation(s)
| | - Bianca Funes
- Saskatchewan Epilepsy Program Division of Neurology Department of Medicine University of Saskatchewan Saskatoon Saskatchewan Canada
| | | | | | | | | | | | - Lizbeth Hernandez Ronquillo
- Saskatchewan Epilepsy Program Division of Neurology Department of Medicine University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Syed Rizvi
- Saskatchewan Epilepsy Program Division of Neurology Department of Medicine University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Wu Adam
- Saskatchewan Epilepsy Program Division of Neurosurgery Department of Surgery University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Jose F Tellez-Zenteno
- Saskatchewan Epilepsy Program Division of Neurology Department of Medicine University of Saskatchewan Saskatoon Saskatchewan Canada
| |
Collapse
|
17
|
Rapport F, Shih P, Mitchell R, Nikpour A, Bleasel A, Herkes G, Vagholkar S, Mumford V. Better evidence for earlier assessment and surgical intervention for refractory epilepsy (The BEST study): a mixed methods study protocol. BMJ Open 2017; 7:e017148. [PMID: 28827267 PMCID: PMC5724135 DOI: 10.1136/bmjopen-2017-017148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION One-third of patients with refractory epilepsy may be candidates for resective surgery, which can lead to positive clinical outcomes if efficiently managed. In Australia, there is currently between a 6-month and 2-year delay for patients who are candidates for respective epilepsy surgery from the point of referral for surgical assessment to the eventual surgical intervention. This is a major challenge for implementation of effective treatment for individuals who could potentially benefit from surgery. This study examines implications of delays following the point of eligibility for surgery, in the assessment and treatment of patients, and the factors causing treatment delays. METHODS AND ANALYSIS Mixed methods design: Observations of qualitative consultations, patient and healthcare professional interviews, and health-related quality of life assessments for a group of 10 patients and six healthcare professionals (group 1); quantitative retrospective medical records' reviews examining longitudinal outcomes for 50 patients assessed for, or undergoing, resective surgery between 2014 and 2016 (group 2); retrospective epidemiological study of all individuals hospitalised with a diagnosis of epilepsy in New South Wales (NSW) in the last 5 years (2012-2016; approximately 11 000 hospitalisations per year, total 55 000), examining health services' use and treatment for individuals with epilepsy, including refractory surgery outcomes (group 3). ETHICS AND DISSEMINATION Ethical approval has been granted by the North Sydney Local Health District Human Research Ethics Committee (HREC/17/HAWKE/22) and the NSW Population & Health Services Research Ethics Committee (HREC/16/CIPHS/1). Results will be disseminated through publications, reports and conference presentations to patients and families, health professionals and researchers.
Collapse
Affiliation(s)
- Frances Rapport
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Patti Shih
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Rebecca Mitchell
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Armin Nikpour
- Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Andrew Bleasel
- University of Sydney, Sydney, Australia
- Westmead Hospital, Westmead, Australia
| | - Geoffrey Herkes
- University of Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - Sanjyot Vagholkar
- Faculty of Medicine and Health Sciences, Primary Care & Wellbeing, Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| |
Collapse
|
18
|
Revisiting racial disparities in access to surgical management of drug-resistant temporal lobe epilepsy post implementation of Affordable Care Act. Clin Neurol Neurosurg 2017; 158:82-89. [DOI: 10.1016/j.clineuro.2017.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/01/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023]
|
19
|
Lin Y, Pan IW, Harris DA, Luerssen TG, Lam S. The Impact of Insurance, Race, and Ethnicity on Age at Surgical Intervention among Children with Nonsyndromic Craniosynostosis. J Pediatr 2015; 166:1289-96. [PMID: 25919736 DOI: 10.1016/j.jpeds.2015.02.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 01/12/2015] [Accepted: 02/04/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the impact of demographic factors, including insurance type, family income, and race/ethnicity, on patient age at the time of surgical intervention for craniosynostosis surgery in the US. STUDY DESIGN The Kids' Inpatient Database was queried for admissions of children younger than 3 years of age undergoing craniosynostosis surgery in 2009. Descriptive data regarding age at surgery for various substrata are reported. Multivariate regression was used to evaluate the effect of patient and hospital characteristics on the age at surgery. RESULTS Children with private insurance were, on average, 6.8 months of age (95% CI 6.2-7.5) at the time of surgery; children with Medicaid were 9.1 months old (95% CI 8.4-9.8). White children received surgery at mean age of 7.2 months (95% CI 6.5-8.0) and black and Hispanic children at a mean age of 9.1 months (95% CI 8.2-10.1). Multivariate regression analysis found Medicaid insurance (beta coefficient [B]=1.93, P<.001), black or Hispanic race/ethnicity (B=1.34, P=.022), and having 2 or more chronic conditions (B=2.86, P<.001) to be significant independent predictors of older age at surgery. CONCLUSION Public insurance and nonwhite race/Hispanic ethnicity were statistically significant predictors for older age at surgery, adjusted for sex, zip code median family income, year, and hospital factors such as size, type, region, and teaching status. Further research into these disparities is warranted.
Collapse
Affiliation(s)
- Yimo Lin
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX; Department of Neurosurgery, Baylor College of Medicine, Houston, TX
| | - I-Wen Pan
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX; Department of Neurosurgery, Baylor College of Medicine, Houston, TX
| | - Dominic A Harris
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX; Department of Neurosurgery, Baylor College of Medicine, Houston, TX
| | - Thomas G Luerssen
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX; Department of Neurosurgery, Baylor College of Medicine, Houston, TX
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX; Department of Neurosurgery, Baylor College of Medicine, Houston, TX.
| |
Collapse
|