Socioeconomic status-related variables impacting pediatric epilepsy management: a retrospective evaluation of 870 patients over a 10-year period

Abstract

OBJECTIVE: The impact of socioeconomic status (SES) on both treatment and follow-up for pediatric epilepsy patients remains unclear given a paucity of literature that assesses the implications these relationships in this subset of patients. We performed a retrospective evaluation of pediatric patients followed by the surgical epilepsy team at our facility over the past decade to determine whether SES-related variables were associated with an inability to maintain compliance with both preoperative and postoperative treatment regimen.

METHODS: We retrospectively reviewed all records of patients presenting for management by the pediatric surgical epilepsy team at our facility over the past decade. These patients all presented to a high-volume, freestanding academic Children’s Hospital with a diagnosis of refractory epilepsy. All patients were followed-up with regardless of whether or not they underwent surgical intervention. Variables evaluated included those that were Resource-Based, including Parental Employment and Work Conditions, Parental Education, Family Income, Access to Food, Access to Housing, Environmental Impact (Geographic Location), and Healthcare Access. Additional variables included Early Childhood Development, Social Occlusion, and Discrimination. Outcome variables included Compliance with Follow-Up Visits (Follow-up to pre-treatment clinic visits), Treatment Recommendations (anti-convulsant usage and surgical intervention, if recommended), and with Continued Follow-Up Post Initiation of Treatment (surgical or medical).

RESULTS: Of the 870 patients that were followed by the surgical epilepsy team, 47% underwent surgical intervention (414). All patients whose cases were reviewed had qualified for California Children’s Services, Special Care Center (CCS, SCC) Epilepsy Services. Given this, patients with private insurance were not more likely to receive medical and/or surgical services (p > 0.001). Additionally, the variable Income was not related to compliance with follow-up care whereas the variable Geographic Location (i.e., distance to the facility) did impact compliance (p < 0.001).

Patients who were referred for surgical intervention and did not undergo medical treatment were more likely to have private insurance (p < 0.001), but not more likely to have lower incomes than those treated medically (p > 0.001). No significant differences were found with regard to Income, Geographic Location, or Insurance Coverage for patients to achieve Engle Class 1 or 2 following surgical intervention (p > 0.001). The sole variable associated with Follow-Up Compliance following surgical and/or medical treatment was Geographic Location (p > 0.001).

CONCLUSIONS: The only variable which correlated with patients not undergoing surgical intervention and/or maintaining follow-up compliance was Geographic Location. Though there was a correlation between lower income and geographic location, the actual physical distance to the facility was a much stronger predictor of compliance with clinic visits. The paucity of SES-related variables is most likely related to the patient’s eligibility to receive both surgical and medical treatment through CCS, SCC once they qualify for surgical epilepsy evaluation, treatment, and follow-up. Further efforts to identify factors in society that affect patients maintaining compliance with treatment are needed in order to deliver the benefits of current medicines to patients and achieve optimal outcomes.