Recent patterns of vagal nerve stimulator use in the United States: Is there a racial disparity?

Abstract

Summary Objective Patients with refractory epilepsy are at a high risk of complications but may not receive the same level of care across racial groups. We aimed to ascertain racial inequalities and trends in the use of a vagal nerve stimulator (VNS) among adult patients with refractory epilepsy. Methods A total of 24 159 adults (18 years and older) with refractory epilepsy from the National Inpatient Sample between the years 2006 and 2014 were included in this analysis. We used a multivariate logistic regression analysis to evaluate independent predictors of VNS use among patients with refractory epilepsy. Covariates included gender, age, insurance type, and household income. In addition, we evaluated for trends in VNS use over the 9‐year period of data collection. Results A total of 1.56% of patients with refractory epilepsy had used a VNS between 2006 and 2014. Overall, there was a trend of decreased use of a VNS between 2006‐2008 (2.1%) and 2012‐2014 (0.9%). In the adjusted multivariate logistic regression analysis, blacks (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.35‐0.77) were significantly less likely to have used a VNS relative to non‐Hispanic whites. Additional factors independently associated with a decreased likelihood of VNS use were age > 65 years (OR = 0.51, 95% CI = 0.28‐0.95) and years 2012‐2014 (OR = 0.44, 95% CI = 0.28‐0.67). Significance There was a trend toward a decrease in the use of a VNS among adult patients with refractory epilepsy. Our results also suggest that black patients with refractory epilepsy were less likely to receive a VNS independently of other variables. Increased work toward effectively reducing racial disparities in access to quality epilepsy care is crucial.

Racial disparities in the utilization of invasive neuromodulation devices for the treatment of drug‐resistant focal epilepsy

“…Sadly, this aligns with many reports on racial disparities across multiple facets of epilepsy care 12 . Consistent with our findings, a previous study using the National Inpatient Sample between the years 2006 and 2014 observed that Blacks were significantly less likely than NHWs to have used VNS independent of other variables 5 . A significant strength of our study comes from the similar racial and ethnic composition of the HEP2 cohort to the US population.…”

“…3,4 Regarding neuromodulation, there is lower utilization of vagus nerve stimulation (VNS) therapy in Black or African Americans when compared to non-Hispanic Whites (NHWs). 5 Little is known about the racial disparities when using other US Food and Drug Administrationapproved stimulation devices for epilepsy such as anterior thalamic nuclei deep brain stimulation (DBS) or responsive neurostimulation (RNS). We set out to determine the use of invasive neuromodulation devices and its distribution according to race and ethnicity in patients participating in the Human Epilepsy Project 2 (HEP2) study.…”

Vagus nerve stimulation for upper limb motor impairment after ischemic stroke

“…In view of different religious beliefs, economics, sociology, and cultures, the acceptance of VNS varied among each race. Previous study showed the racial disparities in access to VNS devices [35] . Therefore, ethnicity might be an influence factor for these outcome measures.…”

“…Previous study showed the racial disparities in access to VNS devices. [35] Therefore, ethnicity might be an influence factor for these outcome measures.…”

Decompressive hemicraniectomy for stroke by race/ethnicity in the United States

“…Studies on disparities in utilization of neurological care in the US [ 17 ] have shown that Hispanics and Blacks are less likely to receive neurologic care than their White counterparts. Similarly, for planned cranial surgery such as epilepsy surgery [ 18 ] and vagal nerve stimulation [ 19 ], an overrepresentation of Non-Hispanic Whites has consistently been reported. Racial disparities have also been reported for emergency neurosurgical procedures such as mechanical thrombectomy among stroke patients although the pattern of disparities may not be similar for mechanical thrombectomy and DHC [ 9 , 20 ].…”