Alcohol-Specific Mortality in People With Epilepsy: Cohort Studies in Two Independent Population-Based Datasets

Abstract

Objectives: The risk of dying by alcohol-specific causes in people with epilepsy has seldom been reported from population-based studies. We aimed to estimate the relative risk of alcohol-specific mortality in people with epilepsy, and the extent to which problematic alcohol use was previously identified in the patients' medical records.Method: We delineated cohort studies in two population-based datasets, the Clinical Practice Research Datalink (CPRD GOLD) in England (January 01, 2001–December 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (January 01, 2001–December 31, 2014), linked to hospitalization and mortality records. People with epilepsy were matched to up to 20 persons without epilepsy on gender, age (±2 years) and registered general practice. We identified alcohol-specific death from Office for National Statistics (ONS) records using specified ICD-10 codes. We further identified prescriptions, interventions and hospitalisations related to alcohol use.Results: In the CPRD GOLD, we identified 9,871 individuals in the incident epilepsy cohort and 185,800 in the comparison cohort and, in the SAIL Databank, these numbers were 5,569 and 110,021, respectively. We identified a five-fold increased risk of alcohol-specific mortality in people with epilepsy vs. those without the condition in our pooled estimate across the two datasets (deprivation-adjusted HR 4.85, 95%CI 3.46–6.79).Conclusions: People with epilepsy are at increased risk of dying by an alcohol-specific cause than those without the disorder. It is plausible that serious alcohol misuse could either contribute to the development of epilepsy or it could commence subsequent to epilepsy being diagnosed. Regardless of the direction of the association, it is important that the risk of dying as a consequence of alcohol misuse is accurately quantified in people affected by epilepsy. Systematically-applied, sensitive assessment of alcohol consumption by healthcare professionals, at opportunistic, clinical contacts, with rapid access to quality treatment services, should be mandatory and play a key role in reduction of health harms and mortality.

Impact of co-morbid common mental disorder symptoms in people with epilepsy in Ethiopia on quality of life and functional disability: a cohort study

“…This decreased substantially (to 1.7%) over the 6-month follow-up period and could explain why baseline risky alcohol use was not associated with either outcome. At baseline alcohol withdrawal could have been the primary cause of seizures (and/or epilepsy) or alcohol use disorder could be comorbid with epilepsy (10).…”

“…Evidence from high-income countries indicates a higher prevalence of alcohol use in PWE compared to the general population (4) which is associated with a higher rate of mortality of PWE (9,10).…”

“…Co-morbid CMDs in people with epilepsy have been associated with poorer seizure treatment outcomes and worse patient-reported health outcomes in high-income country settings (1,(6)(7)(8). In these settings, there is robust, high-quality evidence that people with epilepsy and comorbid CMD have increased risk of poor seizure control (8), premature mortality (9,10), anti-seizure medications side effects (7), poor quality of life (QoL) (6, [11][12][13][14] and increased functional disability (15,16). Comorbid CMDs and substance use have been associated with poor treatment adherence (17,18).…”

Impact of co-morbid common mental disorder symptoms in people with epilepsy in Ethiopia on quality of life and functional disability: cohort study

“…Co-morbid CMDs in people with epilepsy have been associated with poorer seizure treatment outcomes and worse patient-reported health outcomes in high-income country settings (1,(6)(7)(8). In these settings, there is robust, high-quality evidence that people with epilepsy and comorbid CMD have increased risk of poor seizure control (8), premature mortality (9,10), anti-seizure medications side effects (7), poor quality of life (QoL) (6, [11][12][13][14] and increased functional disability (15,16). Comorbid CMDs and substance use have been associated with poor treatment adherence (17,18).…”