Socioeconomic status and epilepsy surgery in the United States: Timing and outcomes.
OBJECTIVE Epilepsy surgery offers curative potential for refractory focal epilepsy, yet it remains underutilized, particularly among socioeconomically disadvantaged populations. In this study, we aim to explore the impact of socioeconomic status on timing and subsequently on outcomes of epilepsy surgery. METHODS This retrospective longitudinal cohort study analyzed 1027 patients who underwent epilepsy surgery at the Cleveland Clinic between 1997 and 2023, using the Area Deprivation Index to assess neighborhood-level socioeconomic status. RESULTS Findings revealed significant delays to surgery and worse baseline mental and physical health among patients from quintiles with lower neighborhood resources. Despite these disparities, seizure freedom (Engel class I) and postoperative improvements in quality of life and mental health were comparable across all socioeconomic strata. SIGNIFICANCE These results underscore the need for equitable access to epilepsy surgery and suggest that socioeconomic status should not delay or deter surgical referral, as outcomes remain robust across diverse populations. We also demonstrate that patients enter surgery on distinct health trajectories shaped by socioeconomic disadvantage, highlighting the need for early identification and intervention to maximize postoperative benefit.