Disparities in Pediatric Epilepsy Remission Are Associated With Race and Ethnicity
Celestine H Yeung Gregerson1, Amanda V Bakian2, Jacob Wilkes3
1School of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Insights
Hispanic children with epilepsy have a lower chance of seizure remission. Factors tied to race/ethnicity may impact seizure freedom in pediatric epilepsy patients.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Epilepsy affects millions of children globally.
- Understanding factors influencing seizure remission is crucial for effective treatment.
- Race and ethnicity may play a role in epilepsy outcomes.
Purpose of the Study:
- To investigate the association between race/ethnicity and seizure remission in pediatric epilepsy.
- To determine if Hispanic ethnicity impacts the likelihood of achieving seizure control.
Main Methods:
- Retrospective population-based cohort study of 776 children (6 months to 15 years) with new-onset epilepsy.
- Data collected from an integrated health care system over 6 years with at least 5 years of follow-up.
- Race, ethnicity, insurance, and socioeconomic factors were evaluated; outcomes categorized as drug-responsive or drug-resistant.
Main Results:
- 63% of patients achieved drug-responsive epilepsy (seizure remission).
- Hispanic children had a reduced likelihood of drug-responsive epilepsy (HR 0.6, P < .001) and longer median time to remission (8 years vs. 5.6 years for white non-Hispanic patients).
- Higher healthcare costs were linked to reduced drug responsiveness in Hispanic patients.
Conclusions:
- Hispanic ethnicity is associated with a lower likelihood of achieving seizure control and remission in pediatric epilepsy.
- Race/ethnicity-related factors may influence a patient's ability to attain seizure freedom.
- Further research is needed to explore the underlying mechanisms and address disparities in epilepsy care.
Objective:
The purpose of our study was to assess whether race/ethnicity was associated with seizure remission in pediatric epilepsy.
Methods:
This was a retrospective population-based cohort study of children who were evaluated for new-onset epilepsy in the clinic, emergency department, and/or hospital by a pediatric neurologist in an integrated health care delivery system. Children were between ages 6 months and 15 years at their initial presentation of epilepsy. The cohort, identified through an electronic database, was assembled over 6 years, with no less than 5 years of follow-up. All children were evaluated for race, ethnicity, insurance type, and socioeconomic background. Patient outcome was determined at the conclusion of the study period and categorized according to their epilepsy control as either drug resistant (pharmacoresistant and intractable) or drug responsive (controlled, probable remission, and terminal remission).
Results:
In the final cohort of 776 patients, 63% were drug responsive (control or seizure remission). After controlling for confounding socioeconomic and demographic factors, children of Hispanic ethnicity experienced reduced likelihood (hazard) of drug-responsive epilepsy (hazard ratio 0.6, P < .001), and had longer median time to remission (8 years; 95% CI 5.9-9.6 years) compared to white non-Hispanic patients (5.6 years; 95% CI 4.9-6.1 years). Among Hispanic patients, higher health care costs were associated with reduced likelihood of drug responsiveness.
Significance:
We found that Hispanic ethnicity is associated with a reduced likelihood of achieving seizure control and remission. This study suggests that factors associated with the race/ethnicity of patients contributes to their likelihood of achieving seizure freedom.
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