Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Neurology, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA. Electronic address: https://twitter.com/@ShreyaLouis.
Department of Neurosurgery, Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA; Case Western Reserve School of Medicine, Cleveland, OH, USA. Electronic address: https://twitter.com/@NickRabah.
Epilepsy Behav. 2021 Dec;125:108409. doi: 10.1016/j.yebeh.2021.108409. Epub 2021 Nov 14.
Prior studies in the field of epilepsy surgical disparities have examined barriers in undergoing epilepsy surgical resections in disadvantaged populations involving trust in health providers, education level, social support, and fear of treatment. Few studies have analyzed the geographical locations of specialized epilepsy centers and their role in nationwide epilepsy surgical access and disparities.
To better visualize the locations of epilepsy level IV centers in the United States with respect to epilepsy prevalence and socioeconomic disadvantage.
We created heat maps of the United States to visualize geographical locations of level IV epilepsy centers with respect to the 2015 state-wide epilepsy prevalence and 2017 county-wide Area Deprivation Index (ADI) scores, a composite measure of socioeconomic disadvantage. Univariate logistic regression was used to test for associations between the presence or absence of epilepsy centers and socioeconomic disadvantage.
We found eight states within the United States without any level IV epilepsy centers. In states with level IV centers, centers were clustered in populated and metropolitan regions. Disadvantaged counties (with increased ADI scores) were less likely to have level IV centers compared to counties that were less disadvantaged (lower ADI scores) (p < 0.00001).
Further work is required to remedy the decreased access to specialized epilepsy care due to geographical disparities, and to better understand its contribution to overall disparities affecting epilepsy surgery referrals.
先前在癫痫手术差异领域的研究检查了在涉及到对医疗服务提供者的信任、教育水平、社会支持和对治疗的恐惧的弱势群体中进行癫痫手术的障碍。很少有研究分析专门的癫痫中心的地理位置及其在全国范围内癫痫手术机会和差异方面的作用。
更好地了解美国四级癫痫中心的地理位置与癫痫发病率和社会经济劣势之间的关系。
我们创建了美国的热点图，以可视化四级癫痫中心的地理位置与 2015 年全州癫痫发病率和 2017 年全县区域贫困指数（ADI）得分（社会经济劣势的综合衡量指标）的关系。使用单变量逻辑回归检验癫痫中心的存在与否与社会经济劣势之间的关联。
我们发现美国有八个州没有任何四级癫痫中心。在有四级中心的州，中心集中在人口密集和大都市地区。与不那么贫困（ADI 得分较低）的县相比，贫困县（ADI 得分较高）拥有四级中心的可能性较小（p<0.00001）。
需要进一步努力，以消除由于地理差异导致的专门癫痫治疗机会减少的问题，并更好地了解其对影响癫痫手术转诊的整体差异的贡献。
