目的:少数可能从癫痫手术中受益的儿科患者接受治疗。这种利用差距的原因是复杂的,并且尚未完全理解。患者和护理人员健康的社会决定因素(SDOH)可能会影响哪些患者接受手术以及何时接受手术。作者进行了一项系统评价,检查了耐药癫痫(DRE)儿童的SDOH和手术干预。他们的目的是了解哪些因素影响DRE患儿手术计划转诊或接受癫痫手术的时间,以及确定表征SDOH影响儿童癫痫手术的领域,并指导旨在促进癫痫健康公平的努力。
方法:使用PubMed进行了系统评价,Embase,以及2022年1月的Scopus数据库。研究通过标题和摘要进行分析,然后全文,确定所有检查SDOH对癫痫手术利用影响的研究。对符合纳入标准的研究进行了SDOH检查分析,结果,和关键发现。质量使用建议分级评估进行评估,开发和评估系统。
结果:在4545篇文章中,包括18个。研究考察了社会,文化,和环境因素导致SDOH影响癫痫手术。接受手术评估的患者最常见的是白人和私人保险,并且有受过大学教育的护理人员。五项研究发现,不同种族的转诊/手术时间或手术率存在差异,对于西班牙裔和/或非白人,大多数发现转诊/手术时间增加或手术率降低。四项研究发现,私人保险与较高的手术利用率有关。三项研究发现,较高的家庭收入与手术利用率有关。没有研究检查生物学,心理,或导致SDOH影响癫痫手术的行为因素。
结论:作者进行了系统评价,探讨SDOH在DRE手术利用中的影响。他们发现那个种族,种族,保险类型,照顾者的教育程度,家庭收入与小儿癫痫手术有关.有必要进一步研究,以了解这些因素是如何,和其他在这项研究中没有发现的,有助于癫痫手术的低使用率和旨在增加儿童获得癫痫手术机会的干预措施的潜在目标领域。
OBJECTIVE: A minority of pediatric patients who may benefit from epilepsy surgery receive it. The reasons for this utilization gap are complex and not completely understood. Patient and caregiver social determinants of health (SDOH) may impact which patients undergo surgery and when. The authors conducted a systematic
review examining SDOH and surgical intervention in children with drug-resistant epilepsy (DRE). They aimed to understand which factors influenced time to surgical program referral or receipt of epilepsy surgery among children with DRE, as well as identify areas to characterize the SDOH impacting epilepsy surgery in children and guide efforts aimed to promote health equity in epilepsy.
METHODS: A systematic
review was conducted using the PubMed, Embase, and Scopus databases in January 2022. Studies were analyzed by title and abstract, then full text, to identify all studies examining the impact of SDOH on utilization of epilepsy surgery. Studies meeting inclusion criteria were analyzed for SDOH examined, outcomes, and key findings. Quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation system.
RESULTS: Of 4545 resultant articles, 18 were included. Studies examined social, cultural, and environmental factors that contributed to SDOH impacting epilepsy surgery. Patients who underwent surgical evaluation were found to be most commonly White and privately insured and have college-educated caregivers. Five studies found differences in time to referral/surgery or rates of surgery by racial group, with most finding an increased time to referral/surgery or lower rates of surgery for those who were Hispanic and/or non-White. Four studies found that private insurance was associated with higher surgical utilization. Three studies found higher household income was related to surgical utilization. No studies examined biological, psychological, or behavioral factors that contributed to SDOH impacting epilepsy surgery.
CONCLUSIONS: The authors conducted a systematic
review exploring the impact of SDOH in DRE surgery utilization. They found that race, ethnicity, insurance type, caregiver educational attainment, and household income demonstrate relationships with pediatric epilepsy surgery. Further study is necessary to understand how these factors, and others not identified in this study, contribute to the low rates of utilization of epilepsy surgery and potential target areas for interventions aiming to increase equity in access to epilepsy surgery in children.