Abstracts

Rationale: The North American population is becoming more diverse. Health needs of emerging ethnic groups may be challenging to health care providers. Disparities in health care involve more than racial/ethnic differences. Educational level, socioeconomic status (SES), age, gender, and place of residence may also play a role. To begin to identify the issues for future research in this area we undertook a systematic review of the evidence on disparities in epilepsy with a focus on North American data (Canada, US, and English-speaking Caribbean). Methods: Scope: Disparities research in the following areas were identified and evaluated: Access to medical and surgical care, outcomes following medical and surgical treatment, disability, incidence & prevalence, and knowledge and attitudes. Literature search and study selection: A medical librarian performed an exhaustive search spanning the years 1965 to 2007. Two independent reviewers selected abstracts of articles that:1)described disparities by SES, race/ethnicity, age, or education of subgroups of the epilepsy population; or 2) described disparities between people with epilepsy and people with other chronic illnesses. The following were excluded: case reports with small samples (N<20), letters, and non-systematic reviews (except to consult their references). Eight reviewers independently selected articles for full text review in each of the issue areas. Data abstraction: Using standardized data forms, two reviewers independently abstracted data from each selected article and then synthesized the body of research.. Results: From 1,455 citations, 278 potentially eligible abstracts were identified and 101 articles were selected for review (see figure). Comparative research data were scarce in all areas reviewed.. People with epilepsy (PWE) have been shown to have lower educational levels and employment status as compared with the general population; among PWEs differences in surgery have been shown by racial/ethnic groups. Because type of insurance and low SES co-vary with race/ethnicity, causality is not clear. Aboriginals, women and children also have been shown to differ from other PWEs in use of specialist, emergency and inpatient health resources, independently of SES or rural residence. Poor compliance with AEDs has been shown to be associated with lower SES, insufficient insurance, poor relationship with treating clinicians, and not having regular responsibilities. Conclusions: There is an urgent need for comprehensive, comparative research on all aspects of disparities in epilepsy. This is a prerequisite for understanding the causes of disparities and the development of any policies aimed at addressing health disparities and minimizing their impact.