The Disparity in Time-to-Surgical Intervention in Patients with Epilepsy in the Inland Empire
Abstract number :
2.08
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2025
Submission ID :
289
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Jovany Pompa, BA, CCRP – Loma Linda University Health
Alexis Duke, BS – Loma Linda University
Mohammad Dastjerdi, MD, PHD – Loma Linda University Health
Mary Safaeipour, MD, MS – Loma Linda University Health
Christina Istrate, MD – Loma Linda University Health
Cindy McKernan, BSN, RN, CPN – Loma Linda University Health
Rationale: Loma Linda University Medical Center, a National Association of Epilepsy Centers (NAEC)-accredited Level 4 Epilepsy Center, serves a population of 4.6 million in the Inland Empire, an area marked by racial, socioeconomic, and linguistic diversity. Despite the availability of comprehensive epilepsy care, delays in epilepsy surgical care remain a concern, particularly among underserved groups. This study aims to identify factors associated with extended time intervals in the surgical pathway in people with epilepsy (PWE).
Methods: We performed a retrospective chart review on 198 patients evaluated for epilepsy surgery between 2016 and 2023. To assess delays in care, we assessed two time intervals: (1) from Epilepsy Monitoring Unit (EMU) discharge to the first surgical conference and (2) from surgical conference to surgical intervention. We used multivariable linear regression to evaluate predictors of delay in these intervals (both as a whole period and yearly intervals) as continuous outcomes. A third logistic regression model was used to investigate predictors of seizure freedom, defined as one year of seizure-free activity following surgery. Covariates included race, primary language spoken, insurance type, internal or external referral, and the California Healthy Places Index (CA HPI) terciles. Lastly, we used a linear probability model (LPM) to assess the binary outcome of whether an intervention was performed, focused on the interaction between CA HPI tercile and primary language.
Results: In Interval 1, the regression model identified no statistically significant predictors of delay. However, there was a trend toward a shorter period for those referred by a Loma Linda neurologist (In Interval 2, Spanish-speaking patients requiring a translator experienced a significant delay of 225 days (p=0.030). The logistic regression revealed that the same cohort was 77% less likely to undergo surgery within a year after the surgical conference (OR=0.23, p=0.037). There were no significant predictors of seizure freedom using the third logistic regression model. In the LPM analysis, English speakers in the lowest CA HPI tercile had a 60.5% probability of receiving an intervention. In comparison, non-English speakers in the same tercile had a 15 percent lower probability (40.5%, p=0.25). Non-English speakers in the highest HPI tercile showed a trend of 40.7% higher probability of receiving an intervention compared to those in the bottom tercile (p=0.106).
Conclusions: Non-English-speaking PWE in the Inland Empire experience significant delays in receiving surgical care and are less likely to proceed to surgery within one year after the surgical conference. Furthermore, from similarly low-HPI neighborhoods, non-English speakers trended toward a lower intervention rate. These findings highlight the disparity in higher levels of epilepsy care for PWE living in the Inland Empire despite addressing linguistic barriers with accessible interpretation services. Further investigation is needed to determine the underlying factors that impact equitable delivery of care for PWE.
Funding: Not Applicable
Health Services (Delivery of Care, Access to Care, Health Care Models)