Sociodemographic barriers in epilepsy surgery in the United States: A systematic review and meta-analysis

IF 2.3 3区医学 Q2 BEHAVIORAL SCIENCES

Epilepsy & Behavior Pub Date : 2025-03-26 DOI:10.1016/j.yebeh.2025.110391

Cemal Karakas , Megan C. Alam , Liam D. Ferreira , Sidharth Nair , Dmitri Kovalev , Zulfi Haneef

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引用次数: 0

Abstract

Objectives

The aim of this study was to perform a systematic review and meta-analysis to identify sociodemographic barriers that could contribute to the underutilization of epilepsy surgery.

Methods

PubMed, EMBASE, and Web of Science databases were systematically reviewed from January 2002 until August 2024. The studies examining the impact of sociodemographic barriers on epilepsy surgery were included. The primary outcomes were the odds ratio (OR) and 95 % confidence intervals (CI) for receiving surgery compared to not-receiving surgery in persons with epilepsy. Race/ethnicity, sex, and insurance had sufficient data to perform a meta-analysis of OR and 95 % CI.

Results

Overall, 1,520,813 patients from 12 studies were evaluated, among which relevant studies were selected for comparing sex (338,170 males and 341,821 females), race (1,056,571 White, 224,693 Hispanic, and 239,549 Black/African-American [Black/AA]), and insurance (232,908 private, 190,849 Medicaid, and 204,478 Medicare). Black/AA patients were significantly less likely to have surgery compared to Whites (OR 0.46, CI 0.35–0.61) or Hispanics (OR: 0.54, CI 0.43–0.67). White patients were more likely to have surgery than other groups examined (OR 1.61, CI 1.28–2.02). There were no significant differences in surgical odds when comparing males to females (OR 1.00, CI 0.97–1.03). Compared to the private insurance, patients with Medicaid (OR 0.61, CI 0.49–0.75) or Medicare (OR: 0.49, CI 0.32–0.77) were less likely to obtain surgery.

Conclusion

This meta-analysis highlights the impact of race/ethnicity, sex, and insurance status in the likelihood of receiving epilepsy surgery and can inform targeted interventions and policies aimed at ensuring equity for disadvantaged groups.

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来源期刊

Epilepsy & Behavior 医学-行为科学

CiteScore

5.40

自引率

15.40%

发文量

385

审稿时长

43 days

期刊介绍： Epilepsy & Behavior is the fastest-growing international journal uniquely devoted to the rapid dissemination of the most current information available on the behavioral aspects of seizures and epilepsy. Epilepsy & Behavior presents original peer-reviewed articles based on laboratory and clinical research. Topics are drawn from a variety of fields, including clinical neurology, neurosurgery, neuropsychiatry, neuropsychology, neurophysiology, neuropharmacology, and neuroimaging. From September 2012 Epilepsy & Behavior stopped accepting Case Reports for publication in the journal. From this date authors who submit to Epilepsy & Behavior will be offered a transfer or asked to resubmit their Case Reports to its new sister journal, Epilepsy & Behavior Case Reports.