Race, socioeconomic status, and geography influence utilization of surgery in Minnesota epilepsy patients.

Abstract

The goal of this study was to examine how race, socioeconomic status, and geography interact to affect the likelihood of epilepsy surgery within a local academic health system in order to inform the development of future interventions to improve access to epilepsy surgery in Minnesota. For this retrospective case-control study, a number of variables, including demographics, comorbidities, insurance status, and geographic location, were extracted from the University of Minnesota's M Health Fairview internal electronic health record dataset. They were then combined with publicly available datasets, including the area deprivation index (ADI). Multivariable logistic regression analysis was performed to identify variables that were associated with surgical intervention. Geospatial information systems (GIS) analysis was then used to explore the relationship between race, ADI, and geography and the likelihood of undergoing epilepsy surgery. Of 6552 unique inpatients with a primary admitting diagnosis of epilepsy, 132 patients underwent epilepsy surgery. Univariable analysis showed significant differences in race, age, sex, and geography of surgical patients. On multivariable analysis, Black patients were less likely to undergo epilepsy surgery (OR 0.46, 95% CI 0.22-0.96; p = 0.04). Patients from the most deprived areas were more likely to receive surgery (ADI quartile 4: OR 2.32, 95% CI 1.10-4.91; p = 0.03). GIS analysis showed that these high ADI quartile patients were located primarily in micropolitan regions and were predominantly White. Insurance status and comorbidities were not significant factors. Race, ADI, and geography all impacted utilization of epilepsy surgery within the authors' institution, but the results in this study differed from those seen in national datasets. Overall, these findings highlight the need for local data to improve health disparities and demonstrate specific pathways for local institutions to improve disparities in epilepsy surgery.