Disparities in epilepsy: report of a systematic review by the North American Commission of the International League Against Epilepsy

Abstract

Purpose: We undertook a systematic review of the evidence on disparities in epilepsy with a focus on North American data (Canada, United States, and the English-speaking Caribbean).

Methods: We identified and evaluated: access to and outcomes following medical and surgical treatment, disability, incidence and prevalence, and knowledge and attitudes. An exhaustive search (1965-2007) was done, including: (1) disparities by socioeconomic status (SES), race/ethnicity, age, or education of subgroups of the epilepsy population; or (2) disparities between people with epilepsy (PWE) and healthy people or with other chronic illnesses.

Results: From 1,455 citations, 278 eligible abstracts were identified and 44 articles were reviewed. Comparative research data were scarce in all areas. PWE have been shown to have lower education and employment status; among PWE, differences in access to surgery have been shown by racial/ethnic groups. Aboriginals, women, and children have been shown to differ in use of health resources. Poor compliance has been shown to be associated with lower SES, insufficient insurance, poor relationship with treating clinicians, and not having regular responsibilities.

Discussion: Comprehensive, comparative research on all aspects of disparities in epilepsy is needed to understand the causes of disparities and the development of any policies aimed at addressing health disparities and minimizing their impact.

Figure 1

Literature search strategy used in the systematic review. Epilepsia © ILAE

Figure 2

The figure shows the evolution of answers from respondents to surveys in 1949, 1969, and 1974 (Caveness et al., 1969, 1974) to the question: have you ever heard or read about the disease called epilepsy, or convulsive seizures? Would you object to having any of your children in school or at play associate with persons who sometimes had seizures? Do you think epilepsy is a form of insanity or not? Do you think people with epilepsy should be employed in jobs like others? PWE, people with epilepsy. Epilepsia © ILAE

Figure 3

The figure shows the differences in how families interviewed in a Canadian epilepsy clinic felt about the sources of information they accessed and their perceived accuracy of this information (Lu et al., 2005). Epilepsia © ILAE

Figure 4

Taken from the Ontario Health Survey (Wiebe et al., 1999), the figure shows the different levels of education (weighted proportions) achieved by the different groups that were analyzed in the study. Epilepsia © ILAE