title: Socioeconomic status influences time to surgery and surgical outcome in pediatric epilepsy surgery.
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.
authors.affiliation: Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Rubinger
authors.affiliation: Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Chan
authors.affiliation: Division of Neurology, University Health Network, Toronto, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Andrade
authors.affiliation: Division of Neurology, Hospital for Sick Children, Toronto, Canada.
authors.forename: Cristina
authors.initials: C
authors.lastname: Go
authors.affiliation: Department of Psychology, University of Toronto, Toronto, Canada.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Smith
authors.affiliation: Division of Neurology, Hospital for Sick Children, Toronto, Canada.
authors.forename: O Carter
authors.initials: OC
authors.lastname: Snead
authors.affiliation: Department of Neurosurgery, Hospital for Sick Children, Toronto, Canada.
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
authors.affiliation: Division of Neurology, Hospital for Sick Children, Toronto, Canada; Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada. Electronic address: Elysa.Widjaja@sickkids.ca.
authors.forename: Elysa
authors.initials: E
authors.lastname: Widjaja
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000191:economics / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000191:economics*; D012923:Social Class; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Pediatric epilepsy surgery; Socioeconomic status; Surgical outcome; Time to surgery