Global disparities in the epilepsy treatment gap: a systematic review.
OBJECTIVE
To describe the magnitude and variation of the epilepsy treatment gap worldwide.


METHODS
We conducted a systematic review of the peer-reviewed literature published from 1 January 1987 to 1 September 2007 in all languages using PubMed and EMBASE. The purpose was to identify population-based studies of epilepsy prevalence that reported the epilepsy treatment gap, defined as the proportion of people with epilepsy who require but do not receive treatment. Negative binomial regression models were used to assess trends and associations.


RESULTS
The treatment gap was over 75% in low-income countries and over 50% in most lower middle- and upper middle-income countries, while many high-income countries had gaps of less than 10%. However, treatment gaps varied widely both between and within countries. They were significantly higher in rural areas (rate ratio, RR: 2.01; 95% confidence interval, CI: 1.40-2.89) and countries with lower World Bank income classification (RR: 1.55; 95% CI: 1.32-1.82). There was no significant trend in treatment gap over time (RR: 0.92; 95% CI: 0.79-1.07).


CONCLUSIONS
There is dramatic global disparity in the care for epilepsy between high- and low- income countries, and between rural and urban settings. Our understanding of the factors affecting the treatment gap is limited; future investigations should explore other potential explanations of the gap.
Meyer
Ana-Claire
AC
San Francisco General Hospital, University of California, 1001 Potrero Avenue (4M62), Box 0870, San Francisco, CA, 94110, United States of America. meyerac@sfgh.ucsf.edu
Dua
Tarun
T
Ma
Juliana
J
Saxena
Shekhar
S
Birbeck
Gretchen
G
D004827:Epilepsy / Q000188:drug therapy*; D014943:Global Health; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans