Evolution of disparities in pediatric epilepsy surgery use over two decades

Alex S. Aguirre; Ellen C. Broekhuizen; Daan A. Pijs; Iván Sánchez Fernández

doi:10.1016/j.seizure.2026.01.020

Evolution of disparities in pediatric epilepsy surgery use over two decades

Alex S. Aguirre
, Ellen C. Broekhuizen
, Daan A. Pijs
, Iván Sánchez Fernández^*

^*Corresponding author for this work

Neurology

Research output: Contribution to journal › Article › Academic

Abstract

Objective:

To describe how disparities in the use of epilepsy surgery have evolved between 2004 and 2024 among children with drug-resistant epilepsy.

Methods:

Retrospective descriptive study using the Pediatric Health Information System database. Outcomes were use of epilepsy surgery and time from first diagnosis of drug-resistant epilepsy to epilepsy surgery, main predictors were type of insurance, race, and ethnicity.

Results:

We studied 50,953 patients with drug-resistant epilepsy (median (p₂₅-p₇₅) age: 8.0 (3.5–13.4) years, 54% males), of whom 7220 (14.2%) patients had at least one epilepsy surgery. The number of epilepsy surgeries per 100 person-years increased from 4.0 in 2004–2006 to 15.8 in 2022–2024. On multivariable analysis, the odds ratio (OR) of receiving epilepsy surgery for patients with private versus public insurance increased from OR: 1.50 (1.25–1.80) in 2004–2006 to OR: 1.75 (1.50–2.04) in 2022–2024; increased for White patients versus Black patients from OR: 1.35 (1.03–1.76) in 2004–2006 to OR: 2.39 (1.86–3.08) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from OR: 1.08 (0.85–1.38) in 2007–2009 (first years with the “Not Hispanic/Latino” category) to OR: 1.23 (1.01–1.51) in 2022–2024. On multivariable Cox regression analysis, the hazard ratio (HR) of receiving epilepsy surgery for patients with private insurance versus public insurance increased from HR: 1.55 (1.32–1.82) in 2004–2006 to HR: 1.92 (1.65–2.24) in 2022–2024; increased for White patients versus Black patients from HR: 1.46 (1.14–1.86) in 2004–2006 to HR: 2.67 (2.05–3.48) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from HR: 1.20 (0.96–1.51) in 2007–2009 to HR: 1.30 (1.06–1.60) in 2022–2024.

Conclusion:

Despite increasing use of epilepsy surgery in pediatric patients with drug-resistant epilepsy between 2004 and 2024, disparities by type of insurance, race, and ethnicity are widening.

Original language	English
Pages (from-to)	4-11
Number of pages	8
Journal	Seizure
Volume	136
DOIs	https://doi.org/10.1016/j.seizure.2026.01.020
Publication status	Published - Mar 2026

Bibliographical note

Publisher Copyright:
© 2026 British Epilepsy Association.

Access to Document

10.1016/j.seizure.2026.01.020

Cite this

@article{745909f783704ce6a943ab9eef9a028a,

title = "Evolution of disparities in pediatric epilepsy surgery use over two decades",

abstract = "Objective:To describe how disparities in the use of epilepsy surgery have evolved between 2004 and 2024 among children with drug-resistant epilepsy. Methods:Retrospective descriptive study using the Pediatric Health Information System database. Outcomes were use of epilepsy surgery and time from first diagnosis of drug-resistant epilepsy to epilepsy surgery, main predictors were type of insurance, race, and ethnicity. Results: We studied 50,953 patients with drug-resistant epilepsy (median (p25-p75) age: 8.0 (3.5–13.4) years, 54\% males), of whom 7220 (14.2\%) patients had at least one epilepsy surgery. The number of epilepsy surgeries per 100 person-years increased from 4.0 in 2004–2006 to 15.8 in 2022–2024. On multivariable analysis, the odds ratio (OR) of receiving epilepsy surgery for patients with private versus public insurance increased from OR: 1.50 (1.25–1.80) in 2004–2006 to OR: 1.75 (1.50–2.04) in 2022–2024; increased for White patients versus Black patients from OR: 1.35 (1.03–1.76) in 2004–2006 to OR: 2.39 (1.86–3.08) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from OR: 1.08 (0.85–1.38) in 2007–2009 (first years with the “Not Hispanic/Latino” category) to OR: 1.23 (1.01–1.51) in 2022–2024. On multivariable Cox regression analysis, the hazard ratio (HR) of receiving epilepsy surgery for patients with private insurance versus public insurance increased from HR: 1.55 (1.32–1.82) in 2004–2006 to HR: 1.92 (1.65–2.24) in 2022–2024; increased for White patients versus Black patients from HR: 1.46 (1.14–1.86) in 2004–2006 to HR: 2.67 (2.05–3.48) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from HR: 1.20 (0.96–1.51) in 2007–2009 to HR: 1.30 (1.06–1.60) in 2022–2024. Conclusion:Despite increasing use of epilepsy surgery in pediatric patients with drug-resistant epilepsy between 2004 and 2024, disparities by type of insurance, race, and ethnicity are widening.",

author = "Aguirre, \{Alex S.\} and Broekhuizen, \{Ellen C.\} and Pijs, \{Daan A.\} and \{S{\'a}nchez Fern{\'a}ndez\}, Iv{\'a}n",

note = "Publisher Copyright: {\textcopyright} 2026 British Epilepsy Association.",

year = "2026",

month = mar,

doi = "10.1016/j.seizure.2026.01.020",

language = "English",

volume = "136",

pages = "4--11",

journal = "Seizure",

issn = "1059-1311",

}

TY - JOUR

T1 - Evolution of disparities in pediatric epilepsy surgery use over two decades

AU - Aguirre, Alex S.

AU - Broekhuizen, Ellen C.

AU - Pijs, Daan A.

AU - Sánchez Fernández, Iván

PY - 2026/3

Y1 - 2026/3

N2 - Objective:To describe how disparities in the use of epilepsy surgery have evolved between 2004 and 2024 among children with drug-resistant epilepsy. Methods:Retrospective descriptive study using the Pediatric Health Information System database. Outcomes were use of epilepsy surgery and time from first diagnosis of drug-resistant epilepsy to epilepsy surgery, main predictors were type of insurance, race, and ethnicity. Results: We studied 50,953 patients with drug-resistant epilepsy (median (p25-p75) age: 8.0 (3.5–13.4) years, 54% males), of whom 7220 (14.2%) patients had at least one epilepsy surgery. The number of epilepsy surgeries per 100 person-years increased from 4.0 in 2004–2006 to 15.8 in 2022–2024. On multivariable analysis, the odds ratio (OR) of receiving epilepsy surgery for patients with private versus public insurance increased from OR: 1.50 (1.25–1.80) in 2004–2006 to OR: 1.75 (1.50–2.04) in 2022–2024; increased for White patients versus Black patients from OR: 1.35 (1.03–1.76) in 2004–2006 to OR: 2.39 (1.86–3.08) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from OR: 1.08 (0.85–1.38) in 2007–2009 (first years with the “Not Hispanic/Latino” category) to OR: 1.23 (1.01–1.51) in 2022–2024. On multivariable Cox regression analysis, the hazard ratio (HR) of receiving epilepsy surgery for patients with private insurance versus public insurance increased from HR: 1.55 (1.32–1.82) in 2004–2006 to HR: 1.92 (1.65–2.24) in 2022–2024; increased for White patients versus Black patients from HR: 1.46 (1.14–1.86) in 2004–2006 to HR: 2.67 (2.05–3.48) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from HR: 1.20 (0.96–1.51) in 2007–2009 to HR: 1.30 (1.06–1.60) in 2022–2024. Conclusion:Despite increasing use of epilepsy surgery in pediatric patients with drug-resistant epilepsy between 2004 and 2024, disparities by type of insurance, race, and ethnicity are widening.

AB - Objective:To describe how disparities in the use of epilepsy surgery have evolved between 2004 and 2024 among children with drug-resistant epilepsy. Methods:Retrospective descriptive study using the Pediatric Health Information System database. Outcomes were use of epilepsy surgery and time from first diagnosis of drug-resistant epilepsy to epilepsy surgery, main predictors were type of insurance, race, and ethnicity. Results: We studied 50,953 patients with drug-resistant epilepsy (median (p25-p75) age: 8.0 (3.5–13.4) years, 54% males), of whom 7220 (14.2%) patients had at least one epilepsy surgery. The number of epilepsy surgeries per 100 person-years increased from 4.0 in 2004–2006 to 15.8 in 2022–2024. On multivariable analysis, the odds ratio (OR) of receiving epilepsy surgery for patients with private versus public insurance increased from OR: 1.50 (1.25–1.80) in 2004–2006 to OR: 1.75 (1.50–2.04) in 2022–2024; increased for White patients versus Black patients from OR: 1.35 (1.03–1.76) in 2004–2006 to OR: 2.39 (1.86–3.08) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from OR: 1.08 (0.85–1.38) in 2007–2009 (first years with the “Not Hispanic/Latino” category) to OR: 1.23 (1.01–1.51) in 2022–2024. On multivariable Cox regression analysis, the hazard ratio (HR) of receiving epilepsy surgery for patients with private insurance versus public insurance increased from HR: 1.55 (1.32–1.82) in 2004–2006 to HR: 1.92 (1.65–2.24) in 2022–2024; increased for White patients versus Black patients from HR: 1.46 (1.14–1.86) in 2004–2006 to HR: 2.67 (2.05–3.48) in 2022–2024; and increased for Not Hispanic/Latino patients versus Hispanic/Latino patients from HR: 1.20 (0.96–1.51) in 2007–2009 to HR: 1.30 (1.06–1.60) in 2022–2024. Conclusion:Despite increasing use of epilepsy surgery in pediatric patients with drug-resistant epilepsy between 2004 and 2024, disparities by type of insurance, race, and ethnicity are widening.

UR - https://www.scopus.com/pages/publications/105029289900

U2 - 10.1016/j.seizure.2026.01.020

DO - 10.1016/j.seizure.2026.01.020

M3 - Article

C2 - 41637925

AN - SCOPUS:105029289900

SN - 1059-1311

VL - 136

SP - 4

EP - 11

JO - Seizure

JF - Seizure

ER -

Evolution of disparities in pediatric epilepsy surgery use over two decades

Abstract

Bibliographical note

Access to Document

Other files and links

Embargoed Document

Fingerprint

Cite this