Racial and Ethnic Disparities in Pediatric Epilepsy Surgery
Abstract number :
3.325
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1826057
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
M. Scott Perry, MD - Cook Children's Medical Center; Robert Arrowood - Cook Children's Medical Center; Allyson Alexander - Neurosurgery - University of Colorado/Children's Hospital Colorado; krista Eschbach - Neurology - University of Colorado/Children's Hospital Colorado; Rani Singh - Atrium Health/Levine Children's Hospital; Michael Ciliberto - Pediatrics - University of Iowa Hospitals and Clinics; Jason Coryell - Oregon Health and Sciences University/Doernbecher Children's Hospital; Dewi Depositario-Cabacar - Center for Neuroscience - George Washington University/Children's National Hospital; Erin Fedak Romanowski - Pediatrics, Division of Pediatric Neurology - Michigan Medicine; Nancy Mcnamara - Pediatrics, Division of Pediatric Neurology - Michigan Medicine; Jeffrey bolton - Neurology - Boston Children's Hospital; Jennifer Koop - Neurology (Neuropsychology) - Medical College of Wisconsin/Children's Hospital of Wisconsin; Ahmad Marashly - Pediatric Neurology - University of Washington/Children's Hospital of Seattle; Ernesto Gonzalez-Giraldo - Pediatric Neurology - University of California-San Francisco; Danilo Bernardo - Pediatric Neurology - University of California-San Francisco; patricia McGoldrick - Neurology - Boston Children's Health Physicians of NY and Connecticut; Steven Wolf - Neurology - Boston Children's Health Physicians of NY and Connecticut; Zachary Grinspan - Pediatric Neurology - Weill-Cornell Medicine; Srishti Nangia - Pediatric Neurology - Weill-Cornell Medicine; Adam Ostendorf - Pediatrics - Ohio State University/Nationwide Children's; Samir Karia - Neurology - University of Louisville School of Medicine/Norton Children's Hospital; Satya Gedela - Pediatrics - Emory University College of Medicine/Children's Healthcare of Atlanta; Shilpa Reddy - Pediatric Neurology - Vanderbilt University/Monroe Carell Jr Children's Hospital; Chad Manuel - Neurology - Vanderbilt University/Monroe Carell Jr Children's Hospital; Daniel Shrey - Neurology - Children's Hospital of Orange County; Primyavada Tatachar - Pediatrics - Ann and Robert H Lurie Children's Hospital; Lily Wong-Kisiel, MD - Neurology - Mayo Clinic College of Medicine
Rationale: Racial and ethnic disparities are pervasive in the US and contribute to poorer health outcomes in non-whites. These disparities are reported in epilepsy surgery. Most prior studies draw conclusions from insurance claims data using primarily adult temporal lobe epilepsy diagnosis and outcome of resective surgery. Limited data exists for pediatric epilepsy surgery and it is unclear where in the surgical evaluation disparities occur (i.e. testing, offering surgery, or decision making).
Methods: The Pediatric Epilepsy Research Consortium Epilepsy Surgery Database is a prospective cross-sectional study collecting common data on all children referred for surgery across 20 US pediatric epilepsy centers. For this analysis, we included patients for whom a first-time presurgical evaluation was completed with a final decision to offer or decline surgery. Demographic characteristics, diagnostic utilization, and surgical outcome were compared by race (white vs non-white) and ethnicity (Hispanic vs non-Hispanic) using logistic regression and analysis of variance controlling for age of onset, insurance type (private vs public), MRI result (lesional vs nonlesional), and neurological exam (normal vs abnormal) when significant in bivariate analysis.
Results: There were 1088 cases in the database. After excluding 226 without conference decision, 243 undergoing repeat phase I evaluation, and 64 with over 75% test data missing at random, the analytic dataset included 555 individuals. Baseline characteristics are presented in Table 1. Of these, 415 (75%) were white, 55 (10%) black, and 84 (15%) other race. Non-Hispanic ethnicity was reported for 466 (84%). Using binary logistic regression, non-white participants had 1.61 [95% C.I = .24, .60] greater odds of fMRI while all other testing (VEEG, PET, SPECT, or MEG) was similar between groups. Hispanic patients had 1.83 [95% C.I. = .34, 1.01] greater odds of MEG while all other testing was similar regardless of ethnicity. Each test was recalculated using additional covariates in the model. Variables influencing use of ancillary testing included nonlesional MRI (p=0.001) and normal exam (p=0.01) for PET, age at evaluation (p=0.03) for SPECT, MRI result (p=0.05) and age of onset (p< 0.001) for fMRI. Controlling for covariates, non-whites had 2.66 [95% C.I = .24, .60] greater odds to receive fMRI. Older age of onset predicted more tests used in evaluation. When controlling for age of onset, neither race nor ethnicity predicted total tests. Race and ethnicity were not associated with the decision to offer epilepsy surgery; however, non-whites were 3.72 [95% C.I = .08, .86] times more likely to personally decline epilepsy surgery.
Surgery