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Disparities in Access to Deep Brain Stimulation and Responsive Neurostimulation Approaches to Drug-Resistant Epilepsy.
Venkatraman, Vishal; Futch, Brittany G; Bartlett, Alyssa; Yang, Lexie Z; Lee, Hui-Jie; Shofty, Ben; Parente, Beth A; Lad, Shivanand P; Williamson, Theresa L; Rahimpour, Shervin.
Afiliación
  • Venkatraman V; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
  • Futch BG; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
  • Bartlett A; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
  • Yang LZ; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.
  • Lee HJ; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.
  • Shofty B; Department of Neurosurgery, University of Utah Health, Salt Lake City, UT, USA.
  • Parente BA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
  • Lad SP; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
  • Williamson TL; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
  • Rahimpour S; Department of Neurosurgery, University of Utah Health, Salt Lake City, UT, USA. Electronic address: Shervin.Rahimpour@hsc.utah.edu.
Neuromodulation ; 27(4): 792-799, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38159098
ABSTRACT

BACKGROUND:

Epilepsy affects 1% to 2% of the global population, and those who are resistant to medical treatment may be candidates for neuromodulation. In select populations, brain stimulation approaches including deep brain stimulation (DBS) and responsive neurostimulation (RNS) are used. Although studies have shown that patients from Black, Hispanic, lower income, and rural communities have less access to epilepsy care and have lower rates of epilepsy surgery, disparities in the use of brain stimulation for epilepsy treatment are currently not known. MATERIALS AND

METHODS:

We queried the US National Inpatient Sample data base from January 1, 2014 to December 31, 2019 for all patients discharged with an International Classification of Diseases (ICD) Ninth Revision or ICD Tenth Revision diagnosis of drug-resistant epilepsy. Among these patients discharged, the rates of brain stimulation treatment, including DBS and RNS, were reported in each subgroup of race, ethnicity, and insurance. To generate national estimates, all analyses were weighted.

RESULTS:

A total of 237,895 patients discharged with drug-resistant epilepsy were identified, of whom 4,925 (2.1%) received brain stimulation treatment for drug-resistant epilepsy. Black patients (n = 420, 0.9%, odds ratio [OR] = 0.51, 95% CI [0.40, 0.64]) were less likely to receive brain stimulation treatment than were White patients (n = 3300, 2.4%). There was no significant difference between Asian (n = 105, 2.3%, OR = 0.80, 95% CI [0.53, 1.33]) and Hispanic (n = 655, 2.6%, OR = 0.95, 95% CI [0.77, 1.17]) patients and White patients. No significant difference was observed between female (n = 2515, 2.1%, OR = 1.02, 95% CI [0.89, 1.17]) and male (n = 2410, 2.0%) patients either. Patients with Medicare (n = 1150, 1.2%, OR = 0.69, 95% CI [0.57, 0.84]) or Medicaid (n = 1150, 1.8%, OR = 0.52, 95% CI [0.44, 0.62]) were less likely to receive brain stimulation treatment than were those with private insurance as the primary payer (n = 2370, 3.9%).

CONCLUSIONS:

We discovered significant disparities in the use of brain stimulation treatments for drug-resistant epilepsy based on race and insurance status. More research will be required to determine the cause of these disparities.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estimulación Encefálica Profunda / Disparidades en Atención de Salud / Epilepsia Refractaria Límite: Adolescent / Adult / Aged / Child / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Neuromodulation Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estimulación Encefálica Profunda / Disparidades en Atención de Salud / Epilepsia Refractaria Límite: Adolescent / Adult / Aged / Child / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Neuromodulation Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos