title: Sociodemographic changes over 25 years of pediatric epilepsy surgery at UCLA.
abstract: OBJECTIVE
  Low income, government insurance, and minority status are associated with delayed treatment for neurosurgery patients. Less is known about the influence of referral location and how socioeconomic factors and referral patterns evolve over time. For pediatric epilepsy surgery patients at the University of California, Los Angeles (UCLA), this study determined how referral location and sociodemographic features have evolved over 25 years.
  
  
  METHODS
  Children undergoing epilepsy neurosurgery at UCLA (453 patients) were classified by location of residence and compared with clinical epilepsy and sociodemographic factors.
  
  
  RESULTS
  From 1986 to 2010, referrals from Southern California increased (+33%) and referrals from outside of California decreased (-19%). Over the same period, the number of patients with preferred provider organization (PPO) and health maintenance organization (HMO) insurance increased (+148% and +69%, respectively) and indemnity insurance decreased (-96%). Likewise, the number of Hispanics (+117%) and Asians (100%) increased and Caucasians/whites decreased (-24%). The number of insurance companies decreased from 52 carriers per 100 surgical patients in 1986-1990 to 19 per 100 in 2006-2010. Patients living in the Eastern US had a younger age at surgery (-46%), shorter intervals from seizure onset to referral for evaluation (-28%) and from presurgical evaluation to surgery (-61%) compared with patients from Southern California. The interval from seizure onset to evaluation was shorter (-33%) for patients from Los Angeles County compared with those living in non-California Western US states.
  
  
  CONCLUSIONS
  Referral locations evolved over 25 years at UCLA, with more cases coming from local regions; the percentage of minority patients also increased. The interval from seizures onset to surgery was shortest for patients living farthest from UCLA but still within the US. Geographic location and race/ethnicity was not associated with differences in becoming seizure free after epilepsy surgery in children.
authors: Departments of Neurosurgery, Mattel Children’s Hospital, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors: Jason S
authors: JS
authors: Hauptman
authors: Andrew
authors: A
authors: Dadour
authors: Taemin
authors: T
authors: Oh
authors: Christine B
authors: CB
authors: Baca
authors: Barbara G
authors: BG
authors: Vickrey
authors: Stefanie D
authors: SD
authors: Vassar
authors: Raman
authors: R
authors: Sankar
authors: Noriko
authors: N
authors: Salamon
authors: Harry V
authors: HV
authors: Vinters
authors: Gary W
authors: GW
authors: Mathern
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D002140:California / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D003710:Demography; D018572:Disease-Free Survival; D004827:Epilepsy / Q000601:surgery*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D009493:Neurosurgery / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology