3Department of Emergency Medicine, Boston University Medical Center, Boston, Massachusetts.
1The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
J Neurosurg. 2024 Jul 5;141(6):1536-1545. doi: 10.3171/2024.4.JNS24528. Print 2024 Dec 1.
Despite the proven efficacy of surgical intervention for achieving seizure freedom and improved quality of life for many epilepsy patients, this treatment remains underutilized. In this study, the authors assessed sociodemographic trends in epilepsy surgery in the National Inpatient Sample (NIS) and the Kids' Inpatient Database (KID) and sought to determine whether disparities in surgical intervention for epilepsy may be attributed to insurance and comorbidity status.
This cross-sectional study utilized data from the NIS database and KID from the Healthcare Cost and Utilization Project between the years 2012 and 2018. Outcomes of interest were rates of neurosurgical intervention, including resection, neuromodulation, or laser ablation. The authors utilized logit regression models to test the association between rates of neurosurgical intervention and the variables of interest and calculated the adjusted mean proportion of patients who received surgery using marginal effects.
Of 336,015 admissions with intractable epilepsy in the NIS, 6.1% were patients who underwent neurosurgical treatment. Of 39,655 admissions from KID, 5.0% received surgical treatment. Private insurance was associated with a greater odds of surgical intervention compared with Medicaid (NIS: OR 1.63, KID: OR 1.62; p < 0.001). Patients assigned White race had an increased odds ratio of undergoing surgery when compared with those assigned Black race, adjusted for comorbidity burden (NIS: OR 1.59, p < 0.001; KID: OR 1.44, p = 0.027). Patients with an Elixhauser Comorbidity Index score of 0 or 1 were associated with a lower likelihood of surgery when compared to their higher scoring counterparts who had 4 or more comorbidities (NIS: OR 0.74, KID: OR 0.62; both p < 0.001).
This study demonstrates that marginalized patients and those with Medicaid had decreased odds of neurosurgical intervention for epilepsy. Results of this research support the need for increased attention toward epilepsy patients from marginalized groups. Further investigation into the root cause of socioeconomic inequities in epilepsy surgery is necessary.
尽管手术干预已被证实能使许多癫痫患者实现无癫痫发作并提高生活质量，但这种治疗方法仍未得到充分利用。本研究评估了国家住院患者样本（NIS）和儿童住院患者数据库（KID）中癫痫手术的社会人口统计学趋势，并试图确定癫痫手术干预的差异是否归因于保险和合并症状况。
本横断面研究利用了医疗保健成本和利用项目（HCUP）的 NIS 数据库和 KID 数据库 2012 年至 2018 年的数据。感兴趣的结果是神经外科干预的比率，包括切除术、神经调节或激光消融。作者使用对数回归模型检验了神经外科干预率与感兴趣变量之间的关联，并使用边缘效应计算了接受手术治疗的患者的调整后平均比例。
在 NIS 中，336015 例难治性癫痫住院患者中，有 6.1%的患者接受了神经外科治疗。在 KID 中，有 39655 例住院患者接受了手术治疗。与医疗补助相比，私人保险与更大的手术干预几率相关（NIS：OR 1.63，KID：OR 1.62；p <0.001）。与黑人相比，被分配为白人种族的患者在调整合并症负担后，手术的比值比更高（NIS：OR 1.59，p <0.001；KID：OR 1.44，p =0.027）。与有 4 种或更多合并症的患者相比，Elixhauser 合并症指数评分 0 或 1 的患者手术的可能性较低（NIS：OR 0.74，KID：OR 0.62；均 p <0.001）。
本研究表明，边缘化患者和 Medicaid 患者进行癫痫神经外科干预的几率较低。本研究结果支持需要更多关注来自边缘化群体的癫痫患者。进一步研究癫痫手术中社会经济不平等的根本原因是必要的。
