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

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 outcome...

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Veröffentlicht in:World neurosurgery 2023-10, Vol.178, p.202-212.e2
Hauptverfasser: Howard, Susanna D., Campbell, Paige-Ashley, Montgomery, Canada T., Tomlinson, Samuel B., Ojukwu, Disep I., Chen, H. Isaac, Chin, Marshall H.
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container_end_page 212.e2
container_issue
container_start_page 202
container_title World neurosurgery
container_volume 178
creator Howard, Susanna D.
Campbell, Paige-Ashley
Montgomery, Canada T.
Tomlinson, Samuel B.
Ojukwu, Disep I.
Chen, H. Isaac
Chin, Marshall H.
description 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. 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. 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. 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.
doi_str_mv 10.1016/j.wneu.2023.07.138
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source Elsevier ScienceDirect Journals Complete
subjects Epilepsy
Health disparities
Inequalities
Insurance
Neurosurgery
Race
Seizures
title Effect of Race and Insurance Type on Access to, and Outcomes of, Epilepsy Surgery: A Literature Review
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