title: Distinguishing language and race disparities in epilepsy surgery.
abstract: This study aimed to identify whether race/ethnicity and limited English proficiency impact the likelihood of pursuing surgical treatment for medically refractory epilepsy. We conducted a retrospective cohort study of 213 patients with medically refractory epilepsy and mesial temporal sclerosis who were being considered for temporal lobectomy between January 1, 1993 and December 31, 2010 with follow-up through December 31, 2012. Demographic and clinical factors potentially associated with surgical utilization, including self-reported race/ethnicity and preferred language, were gathered from the medical record. Patients of Asian/Pacific Islander or African American race were significantly less likely to pursue surgical treatment of epilepsy compared with non-Hispanic whites in a multivariate logistic regression model (adjusted for nonconcordant ictal EEG, age, and limited English proficiency) (OR 0.20, p=0.003; OR 0.15, p=0.001, respectively). Limited English proficiency was also significantly associated with lower odds of surgery (OR 0.38, p=0.034). Both race and limited English proficiency contribute to disparities in the surgical management of medically refractory epilepsy, especially among Asian/Pacific Islanders and African Americans. Culturally sensitive patient-physician communication and patient education materials might aid in surgical decision-making among minority groups.
authors.affiliation: University of California, San Francisco, Department of Neurology, Box 0138, 521 Parnassus Ave, C-440, San Francisco, CA 94143, USA. John.Betjemann@ucsfmedctr.org
authors.forename: John P
authors.initials: JP
authors.lastname: Betjemann
authors.forename: Atalie C
authors.initials: AC
authors.lastname: Thompson
authors.forename: Carlos
authors.initials: C
authors.lastname: Santos-Sánchez
authors.forename: Paul A
authors.initials: PA
authors.lastname: Garcia
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ivey
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D001213:Asian; D015331:Cohort Studies; D004569:Electroencephalography; D004827:Epilepsy / Q000208:ethnology / Q000523:psychology / Q000601:surgery; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D007802:Language; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: ATL; EEG; EMU; Health disparities; Language proficiency; MTS; Mesial temporal sclerosis; NIS; Nationwide Inpatient Sample; Surgical utilization; TLE; Temporal lobectomy; UCSF; University of California, San Francisco; anterior temporal lobectomy; electroencephalogram; epilepsy monitoring unit; mesial temporal sclerosis; temporal lobe epilepsy