Karakas Cemal, Alam Megan C, Ferreira Liam D, Nair Sidharth, Kovalev Dmitri, Haneef Zulfi
Division of Pediatric Neurology, Department of Pediatrics, Norton Children's Hospital, University of Louisville, Louisville, KY 40202, USA.
Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
Epilepsy Behav. 2025 Jun;167:110391. doi: 10.1016/j.yebeh.2025.110391. Epub 2025 Mar 26.
The aim of this study was to perform a systematic review and meta-analysis to identify sociodemographic barriers that could contribute to the underutilization of epilepsy surgery.
PubMed, EMBASE, and Web of Science databases were systematically reviewed from January 2002 until August 2024. The studies examining the impact of sociodemographic barriers on epilepsy surgery were included. The primary outcomes were the odds ratio (OR) and 95 % confidence intervals (CI) for receiving surgery compared to not-receiving surgery in persons with epilepsy. Race/ethnicity, sex, and insurance had sufficient data to perform a meta-analysis of OR and 95 % CI.
Overall, 1,520,813 patients from 12 studies were evaluated, among which relevant studies were selected for comparing sex (338,170 males and 341,821 females), race (1,056,571 White, 224,693 Hispanic, and 239,549 Black/African-American [Black/AA]), and insurance (232,908 private, 190,849 Medicaid, and 204,478 Medicare). Black/AA patients were significantly less likely to have surgery compared to Whites (OR 0.46, CI 0.35-0.61) or Hispanics (OR: 0.54, CI 0.43-0.67). White patients were more likely to have surgery than other groups examined (OR 1.61, CI 1.28-2.02). There were no significant differences in surgical odds when comparing males to females (OR 1.00, CI 0.97-1.03). Compared to the private insurance, patients with Medicaid (OR 0.61, CI 0.49-0.75) or Medicare (OR: 0.49, CI 0.32-0.77) were less likely to obtain surgery.
This meta-analysis highlights the impact of race/ethnicity, sex, and insurance status in the likelihood of receiving epilepsy surgery and can inform targeted interventions and policies aimed at ensuring equity for disadvantaged groups.
本研究旨在进行系统评价和荟萃分析，以确定可能导致癫痫手术利用不足的社会人口学障碍。
对2002年1月至2024年8月期间的PubMed、EMBASE和Web of Science数据库进行了系统检索。纳入了考察社会人口学障碍对癫痫手术影响的研究。主要结局指标是癫痫患者接受手术与未接受手术相比的比值比（OR）和95%置信区间（CI）。种族/民族、性别和保险方面有足够的数据来进行OR和95%CI的荟萃分析。
总体而言，对12项研究中的1520813例患者进行了评估，其中选择相关研究来比较性别（男性338170例，女性341821例）、种族（白人1056571例、西班牙裔224693例、黑人/非裔美国人[黑人/非裔]239549例）和保险情况（私人保险232908例、医疗补助190849例、医疗保险204478例）。与白人（OR 0.46，CI 0.35 - 0.61）或西班牙裔（OR：0.54，CI 0.43 - 0.67）相比，黑人/非裔患者接受手术的可能性显著更低。白人患者接受手术的可能性高于所考察的其他组（OR 1.61，CI 1.28 - 2.02）。比较男性和女性时，手术几率无显著差异（OR 1.00，CI 0.97 - 1.03）。与私人保险相比，医疗补助（OR 0.61，CI 0.49 - 0.75）或医疗保险（OR：0.49，CI 0.32 - 0.77）患者接受手术的可能性更低。
这项荟萃分析突出了种族/民族、性别和保险状况对接受癫痫手术可能性的影响，并可为旨在确保弱势群体公平性的针对性干预措施和政策提供参考。
