Objective: To determine whether, over a long time span, race and/or other predictive factors for patients with intractable temporal lobe epilepsy (TLE) who receive anterior temporal lobectomy (ATL) exist on a national level. Design: Retrospective cohort study. Patients: Adult patients with TLE admitted for ATL (International Classification of Diseases, Ninth Revision, Clinical Modification, 345.41, 345.51; primary procedure code,01.53). Interventions: A population-based analysis was performed using the Nationwide Inpatient Sample from 1988 through 2003. Variables besides race that were examined included patient age, sex, and insurance status. Results: Of the 5779 adults admitted with TLE from 1988 through 2003, 562 (9.7%) received ATL. Multivariate analyses revealed that African American race (odds ratio [OR],0.56; 95% confidence interval [CI],0.38-0.84; P=.005) and increased age (OR,0.98; 95% CI, 0.97-0.99; P<.001 per 1-year increase in age) independently predicted decreased likelihood of receiving ATL for TLE, while private insurance increased the odds of ATL receipt (OR,1.85; 95% CI,1.39-2.46; P<.001). These findings remained stable over time. Conclusions: Fewer than 10% of the TLE patient population receives ATL. Younger age and private insurance are independent predictors of receiving ATL, and African American race independently predicts decreased likelihood of receiving ATL. Despite recent attempts to bridge racial health disparities, the gap between African American and other races in optimal TLE management has remained relatively unchanged on a nationwide level.