The Impact of Social Determinants of Health on Pediatric Epilepsy Surgery
Abstract number :
3.383
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2022
Submission ID :
2204925
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Christopher Beatty, MD – Nationwide Children's Hospital; Lyndsey Gregerson, BS – The Ohio State University; Bryan An, BS – The Ohio State University; Stephanie Ahrens, MD – Nationwide Children's Hospital; Kristen Arredondo, MD – Nationwide Children's Hospital; Jonathan Pindrik, MD – Nationwide Children's Hospital; Ammar Shaikhouni, MD – Nationwide Children's Hospital; Adam Ostendorf, MD – Nationwide Children's Hospital
Rationale: Epilepsy surgery rates in the pediatric population have increased over time, but there is continued under-utilization. Social determinants of health (SDOH) including sex, race, insurance and socioeconomic status have been associated with decreased rates of epilepsy surgery. This study examines the impact of SDOH on progressing from a pre-surgical evaluation to epilepsy surgery and outcomes from epilepsy surgery.
Methods: Children at Nationwide Children’s Hospital who underwent phase 1 pre-surgical evaluation between July 1, 2019, and June 30, 2021, were included in this study. A second cohort of children who underwent epilepsy surgery between June 1, 2012, and June 1, 2021, with surgical outcomes were also analyzed based on most recent epilepsy surgery type for those with more than one type. Sex, race, insurance type, and social needs score (SNS) were analyzed via chi squared, fisher exact test, or logistic regression. SNS is a measure of four areas of social needs including housing instability, food insecurity, lack of transportation, and inability to pay and utilizes a scale of 0-9 with higher values indicating more needs.
Results: A total of 170 children who underwent epilepsy surgery were included in the study. This cohort included 138 white and 32 non-white children; 99 males and 72 females, and 83 patients with commercial insurance and 87 with publicly-funded insurance. A total of 57 children underwent resections, 36 had vagus nerve stimulator placement, 32 underwent hemispherotomy/ectomy, 21 had a corpus callosotomy, 15 had a laser ablation, 5 had responsive neurostimulation placement, and 4 with deep brain stimulator placement. There was no association between sex, race, or insurance type with the surgery type. A total of 111 children had an Engel 1 or 2 outcome at last assessment (65%). Sex and race were not related to Engel outcome. Insurance type was not significant (p=0.06), and SNS was significant with an OR of 1.29 (95% CI, 1.04-1.61) with higher SNS associated with Engel 3-4 outcomes._x000D_
A total of 178 children who underwent phase 1 were included in this analysis. They included 125 white and 53 non-white children, 102 males and 76 females, and 92 patients with commercial insurance and 86 with public insurance. While sex and insurance type were similar between the phase 1 cohort and the surgery cohort, there was a higher percentage of white children who underwent epilepsy surgery, p = 0.028.
Conclusions: Epilepsy surgery outcomes are poorer in children whose families report greater social needs. As has been demonstrated, race is a factor in the progression from pre-surgical evaluation to completion of epilepsy surgery in our cohort. The impacts of SDOH are likely multifactorial impacting access to care, interaction with the healthcare system, and day to day interactions and resources in this population._x000D_
Funding: None
Health Services (Delivery of Care, Access to Care, Health Care Models)