McClelland Shearwood, Guo Hongfei, Okuyemi Kolawole S
Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN 55414, USA.
Arch Neurol. 2010 May;67(5):577-83. doi: 10.1001/archneurol.2010.86.
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.
Retrospective cohort study.
Adult patients with TLE admitted for ATL (International Classification of Diseases, Ninth Revision, Clinical Modification, 345.41, 345.51; primary procedure code, 01.53).
A population-based analysis was performed using the Nationwide Inpatient Sample from 1988 through 2003. Variables besides race that were examined included patient age, sex, and insurance status.
Of the 5779 adults admitted with TLE from 1988 through 2003, 562 (9.7%) received ATL. Multivariate analyses revealed that African American race (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.38-0.84; P = .005) and increased age (OR, 0.98; 95% CI, 0.97-0.99; P < .001 per 1-year increase in age) independently predicted decreased likelihood of receiving ATL for TLE, while private insurance increased the odds of ATL receipt (OR, 1.85; 95% CI, 1.39-2.46; P < .001). These findings remained stable over time.
Fewer than 10% of the TLE patient population receives ATL. Younger age and private insurance are independent predictors of receiving ATL, and African American race independently predicts decreased likelihood of receiving ATL. Despite recent attempts to bridge racial health disparities, the gap between African American and other races in optimal TLE management has remained relatively unchanged on a nationwide level.
确定在全国范围内，长期来看，接受前颞叶切除术（ATL）的顽固性颞叶癫痫（TLE）患者是否存在种族和/或其他预测因素。
回顾性队列研究。
因ATL入院的成年TLE患者（国际疾病分类第九版临床修订本，345.41、345.51；主要手术编码，01.53）。
使用1988年至2003年的全国住院患者样本进行基于人群的分析。除种族外，检查的变量还包括患者年龄、性别和保险状况。
在1988年至2003年因TLE入院的5779名成年人中，562人（9.7%）接受了ATL。多变量分析显示，非裔美国人种族（优势比[OR]，0.56；95%置信区间[CI]，0.38 - 0.84；P = 0.005）和年龄增加（OR，0.98；95%CI，0.97 - 0.99；年龄每增加1岁P < 0.001）独立预测TLE患者接受ATL的可能性降低，而私人保险增加了接受ATL的几率（OR，1.85；95%CI，1.39 - 2.46；P < 0.001）。这些发现随时间保持稳定。
不到10%的TLE患者接受了ATL。较年轻的年龄和私人保险是接受ATL的独立预测因素，而非裔美国人种族独立预测接受ATL的可能性降低。尽管最近试图弥合种族健康差距，但在全国范围内，非裔美国人和其他种族在TLE最佳管理方面的差距相对保持不变。
