Howard Susanna D, Campbell Paige-Ashley, Montgomery Canada T, Tomlinson Samuel B, Ojukwu Disep I, Chen H Isaac, Chin Marshall H
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Surgery, University of California San Francisco, San Francisco, California, USA.
World Neurosurg. 2023 Oct;178:202-212.e2. doi: 10.1016/j.wneu.2023.07.138. Epub 2023 Aug 4.
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.
尽管癫痫发作缓解率较高，但很大一部分可从癫痫手术中获益的药物难治性癫痫患者并未接受手术治疗。这篇文献综述描述了种族和保险状况与癫痫手术可及性及手术效果之间的关联。
在Scopus和PubMed数据库中搜索与癫痫手术差异相关的内容。纳入标准包括可用于比较美国癫痫手术患者按保险类型或种族划分的可及性及手术效果的数据。两名独立评审员确定文章的合格性。
在审查的289项研究中，纳入了26项。大多数研究为回顾性队列研究（26项中的23项）和全国住院数据库研究（26项中的13项）。在评估癫痫手术患者人口统计学特征的17项研究中，11项表明黑人患者比白人患者接受手术的可能性更小，或者从癫痫发作开始到手术的时间更长。9项研究表明，与有公共保险的患者相比，有私人保险的患者更有可能接受癫痫手术，且手术时间更短。未发现手术后癫痫复发率与保险类型或种族之间存在显著关联。
与其他药物难治性癫痫患者相比，黑人患者和有公共保险的患者在经过较长等待期后接受癫痫手术的比例较低。这些结果与当前报道的文献一致。未来的工作应侧重于对这些差异进行更多特征描述和探究潜在原因，以制定成功的干预措施。
