Epilepsy surgery and the racial divide

Racial minorities in the United States receive poorer quality health care and have poorer health outcomes than do nonminorities.1 Differences in economic status and health insurance rates explain some but not all of the disparities in quality of care. There is no evidence that racial differences in health care quality and outcomes are caused by inherent differences in disease or in response to treatment.2 In this issue of Neurology , Burneo et al.3 present a study of seizure surgery among blacks and whites discharged from the University of Alabama at Birmingham hospital after video-EEG monitoring between 1998 and 2000. They studied 130 patients with refractory temporal lobe epilepsy caused by mesial temporal lobe sclerosis. Using multivariate analyses that accounted for socioeconomic status, the authors demonstrated that race is independently associated with a lower likelihood of epilepsy surgery. The results of this study concur with those of others investigating disparities in the use of surgical procedures.1 Why would black patients referred to the same center with the same diagnosis have a lower likelihood of undergoing epilepsy surgery? Patient and physician factors …