Nicholas Rabah, Shreya Louis, Richard Rammo M.D.
The majority of epilepsy patients are treated medically. A subset of patients are drug-resistant and become candidates for epilepsy surgery. Although not all drug-resistant patients are surgical candidates, those who are, have success rates of roughly ~ 80% [1]. The challenge for these drug-resistant patients in obtaining epilepsy surgery often is a result of decreased rates of refferal for epilepsy surgical consultations or a lack of access to nearby epilepsy level 4 centers that specialize in intracranial electrode evaluations, comprehensive neuropsychologic testing, and advanced surgical care.
The Area Deprivation Index (ADI) is based on a measure created by the Health Resources & Services Administration (HRSA) over two decades ago for primarily county-level use, but refined, adapted, and validated to the Census block group/neighborhood level by Amy Kind, MD, PhD [2]. It was initially created by Singh in 2003 to create a measure of socioeconomic disadvantage for neighborhoods based on zip-codes allowing for neighborhood risk to be assessed in an efficient way that is easily accessible to clinicans [2,3]. The ADI takes into account US Census data primarily poverty, housing, education, and employment indicators and has been shown in numerous studies to be associated with health outcomes particularly in cancer (e.g breast, colorectal and prostate cancers)[4].
This is a map of US county-level ADI scores using data from the 2017 US Census American Community Survey-5. The points on the map represent the location of level 4 epilepsy centers. There is a clear lack of access and Level 4 centers in counties with higher ADI scores (representing areas of increased disadvantage).
[1] Epilepsy surgery: Both underused and overhyped. International League Against Epilepsy Accessed August 18 2020. URL:https://www.ilae.org/journals/epigraph/epigraph-vol-20-issue-2-fall-2018/epilepsy-surgery-both-underused-and-overhyped
[2]Kind AJ, Jencks S, Brock J, et al. Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med. 2014;161(11):765-774. doi:10.7326/M13-2946
[3]Singh GK. Area deprivation and widening inequalities in US mortality, 1969-1998. Am J Public Health. 2003;93(7):1137-1143. doi:10.2105/ajph.93.7.1137
[4] Singh GK, Williams SD, Siahpush M, Mulhollen A. Socioeconomic, Rural-Urban, and Racial Inequalities in US Cancer Mortality: Part I-All Cancers and Lung Cancer and Part II-Colorectal, Prostate, Breast, and Cervical Cancers. J Cancer Epidemiol. 2011;2011:107497. doi:10.1155/2011/107497