Socioeconomic status influences time to surgery and surgical outcome in pediatric epilepsy surgery |
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| Institution: | 1. Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada;2. Division of Neurology, University Health Network, Toronto, Canada;3. Division of Neurology, Hospital for Sick Children, Toronto, Canada;4. Department of Psychology, University of Toronto, Toronto, Canada;5. Department of Neurosurgery, Hospital for Sick Children, Toronto, Canada;6. Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada;1. Danish Center for Sleep Medicine, Neurophysiology Clinic, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark;2. Department of Neurology, Aarhus University Hospital, Aarhus, Denmark;3. itracks, Klosterport 4E, 4, Aarhus, Denmark;4. Danish National Institute for Local and Regional Government Research, Copenhagen, Denmark;1. Danish Epilepsy Center, Filadelfia/University of Copenhagen, Kolonivej 1, 4293 Dianalund, Denmark;2. IRCCS Institute of Neurological Sciences, Bellaria Hospital, via Altura 3, 40139 Bologna, Italy;3. Neurophysiology Department, Danish Epilepsy Center, Visbys Alle’ 5, 4293 Dianalund, Denmark; Department of Neurophysiology, Aarhus University, Norrebrogade 44, 8000 Aarhus;4. Department of Clinical Neurophysiology, SEIN — Epilepsy Institute in The Netherlands, Meer en Bosch, The Netherlands;5. Department of CNP at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands;6. Department of Neurosurgery at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands;7. Epilepsy Unit, San Paolo Hospital, Department of Health Sciences, University of Milan, Via Antonio di Rudinì, 8, 20142 Milan, Italy;8. INSERM U836, Univ. Grenoble Alpes, GIN, and Epilepsy Unit, Michallon Hospital, Boulevard de la Chantourne BP 217, 38043 Grenoble Cedex 9, France;9. Epilepsy Center Erlangen (ZEE), University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany;10. Servicio de Neurologia, Hospital Ruber Internacional, Calle de la Masó, 38, 28034 Madrid, Spain;11. Epilepsiezentrum Kork, Landstraße 1, 77694 Kehl-Kork, Germany;12. Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Strubergasse 21, 5020 Salzburg, Austria;13. Department of Clinical Neurosciences, CHUV, Bâtiment Champ de l''Air Rue du Bugnon 21, 1011 Lausanne, Switzerland;14. Translational and Integrative Group in Epilepsy Research (TIGER) and Institute for Epilepsies (IDEE), Lyon''s Neuroscience Center, INSERM U1028, CNRS 5292, UCBL, Centre Hospitalier Le Vinatier 95 Bd Pinel, 69500 Bron, Lyon, France;1. Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada;2. Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada;3. Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada;4. Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada;5. Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada;1. Seizure Disorder Center, Department of Neurology, UCLA, USA;2. School of Nursing, UCLA, USA |
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| Abstract: | The aims of this study were to evaluate the influence of socioeconomic status (SES) on time-to-surgery (TTS) and surgical outcome in children with treatment-resistant epilepsy in a universal health care system. The cohort consisted of children who had undergone resective epilepsy surgery between 2001 and 2013 in Canada. The patients' postal codes were linked to Statistics Canada National Household Survey data to obtain dissemination area income, which was used to infer SES. Time-to-surgery was defined as the interval from date of epilepsy onset to date of surgery. Seizure outcome was classified using ILAE classification. The associations between SES and TTS, as well as SES and surgical outcome, were assessed. Two hundred eighty-four children who had epilepsy surgery were included. Patients in the lowest income quintile had a significantly higher TTS relative to the highest income quintile (β = 0.121, p = 0.044). There were no significant associations between income quintiles and seizure-free surgical outcome (odds ratio (OR) = 0.746–1.494, all p > 0.05). However, patients in the lowest income quintile had a significantly lower odds of an improvement in seizure frequency relative to the highest income quintile (OR = 0.262, p = 0.046). The TTS was not uniform across SES in spite of the existence of a universal health care system. This finding highlights the need to address social and economic barriers for epilepsy surgery to improve access to this potentially curative treatment. Those with lower SES had lower likelihood of improvement in seizure control following epilepsy surgery and may require additional support including social and financial support to mitigate the discrepancies in seizure control following surgery between SES levels. |
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