Winterhalter Emily, LoPresti Melissa A, Widjaja Elysa, Mohapatra Aman, Shlobin Nathan A, Zhang Lu, Lam Sandi
1Division of Pediatric Neurosurgery, Lurie Children's Hospital, and Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
2Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York.
J Neurosurg Pediatr. 2024 Apr 5;34(1):30-39. doi: 10.3171/2024.1.PEDS23128. Print 2024 Jul 1.
A minority of pediatric patients who may benefit from epilepsy surgery receive it. The reasons for this utilization gap are complex and not completely understood. Patient and caregiver social determinants of health (SDOH) may impact which patients undergo surgery and when. The authors conducted a systematic review examining SDOH and surgical intervention in children with drug-resistant epilepsy (DRE). They aimed to understand which factors influenced time to surgical program referral or receipt of epilepsy surgery among children with DRE, as well as identify areas to characterize the SDOH impacting epilepsy surgery in children and guide efforts aimed to promote health equity in epilepsy.
A systematic review was conducted using the PubMed, Embase, and Scopus databases in January 2022. Studies were analyzed by title and abstract, then full text, to identify all studies examining the impact of SDOH on utilization of epilepsy surgery. Studies meeting inclusion criteria were analyzed for SDOH examined, outcomes, and key findings. Quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation system.
Of 4545 resultant articles, 18 were included. Studies examined social, cultural, and environmental factors that contributed to SDOH impacting epilepsy surgery. Patients who underwent surgical evaluation were found to be most commonly White and privately insured and have college-educated caregivers. Five studies found differences in time to referral/surgery or rates of surgery by racial group, with most finding an increased time to referral/surgery or lower rates of surgery for those who were Hispanic and/or non-White. Four studies found that private insurance was associated with higher surgical utilization. Three studies found higher household income was related to surgical utilization. No studies examined biological, psychological, or behavioral factors that contributed to SDOH impacting epilepsy surgery.
The authors conducted a systematic review exploring the impact of SDOH in DRE surgery utilization. They found that race, ethnicity, insurance type, caregiver educational attainment, and household income demonstrate relationships with pediatric epilepsy surgery. Further study is necessary to understand how these factors, and others not identified in this study, contribute to the low rates of utilization of epilepsy surgery and potential target areas for interventions aiming to increase equity in access to epilepsy surgery in children.
少数可能从癫痫手术中获益的儿科患者接受了该手术。这种利用差距的原因很复杂，尚未完全了解。患者及照料者的健康社会决定因素（SDOH）可能会影响哪些患者接受手术以及何时接受手术。作者进行了一项系统评价，研究SDOH与耐药性癫痫（DRE）患儿手术干预之间的关系。他们旨在了解哪些因素影响了DRE患儿转诊至手术项目或接受癫痫手术的时间，并确定SDOH影响儿童癫痫手术的特征领域，以指导旨在促进癫痫健康公平性的工作。
2022年1月使用PubMed、Embase和Scopus数据库进行了一项系统评价。通过标题和摘要对研究进行分析，然后分析全文，以确定所有研究SDOH对癫痫手术利用影响的研究。对符合纳入标准的研究进行分析，以了解所研究的SDOH、结果和主要发现。使用推荐分级评估、制定和评价系统对质量进行评估。
在4545篇文章中，纳入了18篇。研究考察了导致SDOH影响癫痫手术的社会、文化和环境因素。接受手术评估的患者最常见的是白人，有私人保险，照料者受过大学教育。五项研究发现不同种族群体在转诊/手术时间或手术率方面存在差异，大多数研究发现西班牙裔和/或非白人患者的转诊/手术时间延长或手术率较低。四项研究发现私人保险与更高的手术利用率相关。三项研究发现家庭收入较高与手术利用率相关。没有研究考察导致SDOH影响癫痫手术的生物学、心理或行为因素。
作者进行了一项系统评价，探讨SDOH对DRE手术利用的影响。他们发现种族、民族、保险类型、照料者教育程度和家庭收入与儿科癫痫手术有关。有必要进一步研究这些因素以及本研究中未确定的其他因素如何导致癫痫手术利用率低，以及旨在提高儿童癫痫手术可及性公平性的潜在干预目标领域。
