FACETS of health disparities in epilepsy surgery and gaps that need to be addressed

Nathan, Cody; Gutierrez, Camilo

doi:10.1212/cpj.0000000000000490

Cited by 36 publications

(28 citation statements)

References 30 publications

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“…36 Therefore, we must consider the ways that institutionalized racism (structurally driven differences in access to resources and opportunities) and interpersonal racism (individuals' implicit or explicit prejudice and discrimination) contribute to our finding. 36 In this context, the FACETS framework, 37 developed to understand drivers of inequities for epilepsy surgery, may be applicable to understanding our findings and working to address them. FACETS stands for: (1) fear of treatment; (2) access to care; (3) communication barriers; (4) education; (5) trust; and (6) social support (Table 5).…”

Section: Discussionmentioning

confidence: 99%

Inequities in Therapy for Infantile Spasms: A Call to Action

Bäumer

Mytinger

Neville

et al. 2022

Annals of Neurology

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The aim of this study was to determine whether selection of treatment for children with infantile spasms (IS) varies by race/ethnicity. Methods: The prospective US National Infantile Spasms Consortium database includes children with IS treated from 2012 to 2018. We examined the relationship between race/ethnicity and receipt of standard IS therapy (prednisolone, adrenocorticotropic hormone, vigabatrin), adjusting for demographic and clinical variables using logistic regression. Our primary outcome was treatment course, which considered therapy prescribed for the first and, when needed, the second IS treatment together. Results: Of 555 children, 324 (58%) were non-Hispanic white, 55 (10%) non-Hispanic Black, 24 (4%) non-Hispanic Asian, 80 (14%) Hispanic, and 72 (13%) other/unknown. Most (398, 72%) received a standard treatment course. Insurance type, geographic location, history of prematurity, prior seizures, developmental delay or regression, abnormal head circumference, hypsarrhythmia, and IS etiologies were associated with standard therapy. In adjusted models, non-Hispanic Black children had lower odds of receiving a standard treatment course compared with non-Hispanic white children (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.20-0.89; p = 0.02).

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Section: Discussionmentioning

confidence: 99%

Inequities in Therapy for Infantile Spasms: A Call to Action

Bäumer

Mytinger

Neville

et al. 2022

Annals of Neurology

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“…The six factors are patient fear, access, communication barriers, education, trust, and social support and physician bias. [ 14 ] The authors recommended interventions such as provider bias and cultural communication training, visual aids and handouts to explain procedures, community engagement, and social work involvement. [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 14 ] The authors recommended interventions such as provider bias and cultural communication training, visual aids and handouts to explain procedures, community engagement, and social work involvement. [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

“…e six factors are patient fear, access, communication barriers, education, trust, and social support and physician bias. [14] e authors recommended interventions such as provider bias and cultural communication training, visual aids and handouts to explain procedures, community engagement, and social work involvement. [14] Schlitz et al highlights the possibility of minimally-invasive epilepsy surgery for patients with disadvantaged patients but is not convinced that access will be broadened beyond large academic centers in the near future.…”

Section: Geographic Barriers To Epilepsy Surgerymentioning

confidence: 99%

“…[14] e authors recommended interventions such as provider bias and cultural communication training, visual aids and handouts to explain procedures, community engagement, and social work involvement. [14] Schlitz et al highlights the possibility of minimally-invasive epilepsy surgery for patients with disadvantaged patients but is not convinced that access will be broadened beyond large academic centers in the near future. ey argue that behavioral and social strategies will be more effective to address the surgical access gap for medically refractory epilepsy.…”

Section: Geographic Barriers To Epilepsy Surgerymentioning

confidence: 99%

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Utilization of epilepsy surgery in the United States: A study of the National Inpatient Sample investigating the roles of race, socioeconomic status, and insurance

Bernstein

Kashyap

Kortz

et al. 2021

Surgical Neurology International

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Background: Epilepsy is estimated to affect 70 million people worldwide and is medically refractory in 30% of cases. Methods: This is a retrospective cross-sectional study using a US database from 2012 to 2014 to identify patients aged ≥18 years admitted to the hospital with epilepsy as the primary diagnosis. The sampled population was weighted using Healthcare Cost and Utilization Project guidelines. Procedural ICD-9 codes were utilized to stratify the sampled population into two cohorts: resective surgery and implantation or stimulation procedure. Results: Query of the database yielded 152,925 inpatients, of which 8535 patients underwent surgical intervention. The nonprocedural group consisted of 76,000 White patients (52.6%) and 28,390 Black patients (19.7%) while the procedural group comprised 5550 White patients (64%) and 730 Black patients (8.6%) (P < 0.001). Patients with Medicare were half as likely to receive a surgical procedure (14.8% vs. 28.4%) while patients with private insurance were twice as likely to receive a procedure (53.4% vs. 29.3%), both were statistically significant (P < 0.01). Those in the lowest median household income quartile by zip code (<$40,000) were 68% less likely to receive a procedure (21.5% vs. 31.4%) while the highest income quartile was 133% more likely to receive a procedure (26.1% vs. 19.5%). Patients from rural and urban nonteaching hospitals were, by a wide margin, less likely to receive a surgical procedure. Conclusion: We demonstrate an area of need and significant improvement at institutions that have the resources and capability to perform epilepsy surgery. The data show that institutions may not be performing enough epilepsy surgery as a result of racial and socioeconomic bias. Admissions for epilepsy continue to increase without a similar trend for epilepsy surgery despite its documented effectiveness. Race, socioeconomic status, and insurance all represent significant barriers in access to epilepsy surgery. The barriers can be remedied by improving referral patterns and implementing cost-effective measures to improve inpatient epilepsy services in rural and nonteaching hospitals.

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Strengthened through Diversity: A Blueprint for Organizational Change

Willis

Skolarus

Faigle

et al. 2021

Annals of Neurology

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R ecently, health care and medicine have broadly sharpened their focus on inequity, unconscious bias, and systemic racism. Accordingly, the field of neurology has identified serious challenges in our culture, academic structures, training, and, most importantly, disparities in access to and receipt of quality care for neurological disease. For the past decade, the American Neurological Association (ANA) has been changing its structure to welcome a broader and more diverse membership within the clinical, educational, and scientific domains of academic neurology. These acts arise from the ANA's aspirations to develop a more inclusive and equitable internal culture and serve as a resource to academic neurology departments seeking to promote equity of opportunity for neurologists and neuroscientists in research, education, and clinical care. The ultimate goal of these actions is to achieve equity in neurological research, health, and care.According to the principle of inclusive excellence, "Diversity is a key component of a comprehensive strategy for achieving institutional excellence." 1 The success of an academic community or institution depends on how well it values, engages, promotes, and includes a richly diverse constituency of students, staff, faculty, administrators, and alumni. Not only is this a moral imperative, but there is empirical evidence that diverse scientific or corporate teams are more productive and more creative. Teams that include different kinds of thinkers or diverse perspectives outperform homogenous groups on complex tasks, producing what has been called "diversity bonuses." 2 Thus, diversity, equity, and inclusion (DEI) efforts are as critical to an academic institution's success as human and animal research protections, fiscal responsibility, and scientific integrity. Given that clinical neuroscience is evolving rapidly and the diversity among medical school applicants, matriculants, and graduates is growing, embracing and achieving diversity in the ANA and academic neurology are critical to our success. In this commentary, we outline some of the areas that need urgent attention and then the actionable steps that have been implemented.Recent events have underscored these imperatives. The COVID-19 pandemic has generated a global health crisis. Current infection rates are on track to exceed those TABLE 2. Respondent Characteristics-Self-Reported Experience with Discrimination in Home Academic Neurological Department and in the 2020 ANA Survey Response Considered Leaving My Home Institution Due to Discrimination Considered Leaving the ANA Due to Discrimination n % n % Yes 39 14.0 6 2.1 No 227 81.6 264 95.0 Declined to answer 12 4.3 8 2.9

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FACETS of health disparities in epilepsy surgery and gaps that need to be addressed

Abstract: This article explains possible reasons outlined by FACETS for the health disparities in epilepsy surgery that exist in patients of a certain race, socioeconomic status, and language proficiency.

Cited by 36 publications

References 30 publications

Inequities in Therapy for Infantile Spasms: A Call to Action

Inequities in Therapy for Infantile Spasms: A Call to Action

Utilization of epilepsy surgery in the United States: A study of the National Inpatient Sample investigating the roles of race, socioeconomic status, and insurance

Strengthened through Diversity: A Blueprint for Organizational Change

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