Racial Disparities In the Surgical Management of Intractable Temporal Lobe Epilepsy In The United States: A Population-Based Analysis
Shearwood McClelland III M.D.1,4, Hongfei Guo Ph.D.2, Kolawole S. Okuyemi M.D., M.P.H. 3,4
1Department of Neurological Surgery, Boston University School of Medicine, Boston, MA; 2Division of Biostatistics and Clinical and Translational Science Institute, University of Minnesota School of Public Health, Minneapolis, MN; 3Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN; 4Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN
Introduction:
Anterior temporal lobectomy (ATL) has emerged as the most effective modality for the treatment of intractable temporal lobe epilepsy (TLE), having been proven far superior to continued medical management. Previous reports from single hospitals indicate that the proportion of ATL performed on African-American TLE patients may be far less than on non-African-American patients. This study was performed to determine whether, over a long time span, race and/or other predictive factors for TLE patients receiving ATL exist on a national level.
Methods:
A retrospective cohort study was performed using the Nationwide Inpatient Sample from 1988-2003. Only adult TLE patients admitted for ATL (ICD-9-CM = 345.41, 345.51; primary procedure code = 01.53) were included. Among other variables besides race examined were patient age, sex, and insurance status.
Results:
Of the 5779 adults admitted with TLE from 1988-2003, 562 (9.7%) received ATL. Multivariate analyses revealed that African-American race (OR=0.56, 95% CI=0.38-0.84, p=0.005) and increased age (OR=0.98, 95% CI=0.97-0.99, p=0.0002 per one year increase in age) independently predicted decreased likelihood of receiving ATL for TLE, while private insurance increased the odds of ATL receipt (OR=1.85, 95% CI=1.39-2.46, p<0.0001). These findings remained stable over time.
Conclusion:
Fewer than 10% of the TLE patient population receives ATL. Younger age and private insurance are independent predictors of receiving ATL, and African-American race independently predicts decreased likelihood of receiving ATL. Despite recent attempts to bridge racial health disparities, the gap between African-Americans and non-African-Americans in optimal TLE management has remained relatively unchanged on a nationwide level.
Keywords:
Intractable Temporal Lobe Epilepsy, Anterior Temporal Lobectomy, African-American Patients, Racial Health Disparities