Common comorbidities in women and men with epilepsy and the relationship between number of comorbidities and health plan paid costs in 2010

Wilner, Andrew N.; Sharma, Bal Krishan; Soucy, Alison; Thompson, Andrew R.; Krueger, Andrew

doi:10.1016/j.yebeh.2013.12.032

Cited by 44 publications

(32 citation statements)

References 14 publications

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“…Our findings are consistent with other reports noting that psychiatric comorbidity substantially increases healthcare use in people with epilepsy [29,30]. …”

Section: Discussionsupporting

confidence: 93%

“…In the study by Wilner, having one comorbidity approximately tripled the health-care costs compared to individuals without comorbidity. Individuals with epilepsy in our safety-net care system sample had higher rates of psychiatric diagnoses than those in the report by Wilner [29], which may be reflective of differences in commercially insured vs. publicly insured groups. An additional important difference in our sample compared to the report by Wilner and colleagues [29] is the fact that our safety-net health system sample focused on those with more severe mental illness, such as chronic psychosis or bipolar disorder, vs. a broader (and potentially less disabling) group of mental conditions, such as anxiety or mild depression.…”

Section: Discussionmentioning

confidence: 65%

“…Wilner and colleagues [29] recently reported that, in a study involving 6621 individuals with epilepsy from eight commercial health plans, 50% of men and 43% of women with epilepsy had 1 or more comorbidities. Psychiatric diagnoses were the top comorbidity for both women and men in this commercially-insured sample.…”

Section: Discussionmentioning

confidence: 99%

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Electronic medical record analysis of emergency room visits and hospitalizations in individuals with epilepsy and mental illness comorbidity

Sajatovic

Welter

Tatsuoka

et al. 2015

Epilepsy & Behavior

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Objective Epilepsy is a chronic neurological condition that significantly increases risk of injury and premature death. Rates of mental illness are also disproportionately high in those with epilepsy, which can be attributed in part to the stress and stigma associated with epilepsy. Psychiatric conditions generally complicate the management of epilepsy, and understanding how psychiatric comorbidity affects use of crisis-based health resources could inform care approaches that help improve epilepsy care. To better understand effects of psychiatric comorbidity on epilepsy burden, we conducted a 5-year retrospective analysis of data from a large safety-net healthcare network and compared the occurrence of negative health events (NHEs), defined as emergency department (ED) visits and hospitalizations, among individuals with epilepsy and mental illness (E–MI) vs. those with epilepsy alone (E). Methods Electronic health record (EHR) data from a large Midwestern U.S. safety-net healthcare system were queried to identify a study population of adults ≥18 years with a diagnosis of epilepsy, with or without mental illness. We assessed demographic and clinical characteristics for each of the 5 years and compared NHEs between subgroups with E–MI vs. E. An additional analysis focused on those individuals who remained in the healthcare system over the entire 5-year study time frame (January, 2010 to December, 2014). Annual and cumulative NHE counts and hospital length of stay for individuals with E–MI and E were assessed, as were hospital discharge diagnoses. Results The number (approximately 2000) and demographic characteristics of individuals with epilepsy who received care each year of the study period was relatively consistent. In 2014, mean age of individuals with epilepsy was 48 (range: 18–95), 48.2% were women, 51.5% were White, 37.9% were African-American, and 8.6% were Hispanic. In 2014, there were 1616 (78.6%) individuals in the subgroup with E and 439 (21.4%) in the subgroup with E–MI. Most clinical and demographic variables between the subgroups with E–MI and E were similar, except that individuals with E–MI were less likely to be employed or commercially insured. Overall, NHEs were common, with over 1/4 (27.5%) of all individuals with epilepsy having an ED visit during the year, 13.7% having hospitalization, and 34.2% having either an ED visit or hospitalization. Individuals with E–MI had significantly more NHEs compared to individuals with epilepsy only, as evidenced by higher rates of any NHE (p < .001), ED visits (p < .001), and hospitalizations (p < .001). The cumulative differential in ED and hospital use between subgroups with E–MI and E was substantial over a 5-year time period. While most NHEs were directly related to seizures for the overall group, substance-use complications appeared as a top reason for hospitalization only in the group with E–MI. Conclusions Individuals with E–MI made up just over 20% of all people with epilepsy in a safety-net system and had higher rates of NHEs than those witho...

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“…Our findings are consistent with other reports noting that psychiatric comorbidity substantially increases healthcare use in people with epilepsy [29,30]. …”

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 65%

See 1 more Smart Citation

Electronic medical record analysis of emergency room visits and hospitalizations in individuals with epilepsy and mental illness comorbidity

Sajatovic

Welter

Tatsuoka

et al. 2015

Epilepsy & Behavior

View full text Add to dashboard Cite

show abstract

“…According to the study presented by Wilner et al [30], on a group of patients older than 19 years with epilepsy, hypertension was the most common comorbid condition. This observation suggests that hypertension may play an important role in epilepsy.…”

Section: Hypertension and Epilepsymentioning

confidence: 99%

Epilepsy and hypertension: The possible link for sudden unexpected death in epilepsy?

et al. 2021

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Epilepsy affects about 50 million people worldwide. Sudden unexpected death in epilepsy (SUDEP) is the main cause of death in epilepsy accounting for up to 17% of all deaths in epileptic patients, and therefore remains a major public health problem. SUDEP likely arises from a combination and interaction of multiple risk factors (such as being male, drug resistance, frequent generalized tonic-clonic seizures) making risk prediction and mitigation challenging. While there is a general understanding of the physiopathology of SUDEP, mechanistic hypotheses linking risk factors with a risk of SUDEP are still lacking. Identifying cross-talk between biological systems implicated in SUDEP may facilitate the development of improved models for SUDEP risk assessment, treatment and clinical management. In this review, the aim was to explore an overlap between the pathophysiology of hypertension, cardiovascular disease and epilepsy, and discuss its implication for SUDEP. Presented herein, evidence in literature in support of a cross-talk between the renin-angiotensin system (RAS) and sympathetic nervous system, both known to be involved in the development of hypertension and cardiovascular disease, and as one of the underlying mechanisms of SUDEP. This article also provides a brief description of local RAS in brain neuroinflammation and the role of centrally acting RAS inhibitors in epileptic seizure alleviation.

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“…12 A study performed in the US found that psychiatric comorbidity was one of several conditions commonly found in both male and female PLWE. 13 Because the impact of stigma on the lives of PLWE is often underestimated by healthcare workers, 14 and epilepsy-related stigma has such far-reaching consequences, identifying factors associated with increased stigma against PLWE at high risk of poor outcomes might help inform care methods for reducing their epilepsy burden. The primary objective of this study was to determine whether demographic and clinical correlates of stigma in a population considered at high risk due to recently experiencing frequent seizures in addition to experiencing other negative health events (NHEs) might differ from those found in previous studies reported in the literature.…”

Section: Jcnmentioning

confidence: 99%

Correlates of Stigma in People with Epilepsy

et al. 2020

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Background and Purpose Epilepsy is often associated with substantial stigma. This study evaluated clinical correlates of stigma in a sample of people living with epilepsy (PLWE) considered high risk due to frequent seizures or other negative health events. Methods Data were derived from an epilepsy self-management clinical trial. Standardized measures assessed socio-demographics, epilepsy stigma, epilepsy severity, self-efficacy, selfmanagement competency, health literacy, depressive symptoms severity, functional status, social support and quality of life. Results There were 120 individuals, mean age of 41.73 (SD=17.08), 81 men (66.9%), and 79 (65.3%) African-American. Individual factors correlated with worse stigma w ere indicative of more severe or poorly controlled seizures (frequent seizures, worse seizure severity scores, more antiepileptic drugs), mental health comorbidity (worse depression severity, other comorbidities) and factors related to individual functioning and perceived competency in managing their health (health literacy, health functioning, self-efficacy, quality of life). Multivariable linear regression found that worse quality of life, and having a mental condition were associated with more stigma (β=6.4 and 6.8, respectively), while higher self-efficacy, health literacy and social support were associated with less stigma (β=-0.06,-2.1, and-0.3, respectively). These five variables explained 50% of stigma variation. Conclusions Stigma burden can be substantial among PLWE and may vary depending on contextual factors such as mental health comorbidity. Care approaches that screen for psychiatric comorbidities, address low health literacy, institute promising self-management programs, and employ effective health communication strategies about epilepsy misconceptions, may reduce epilepsy related burden.

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Common comorbidities in women and men with epilepsy and the relationship between number of comorbidities and health plan paid costs in 2010

Cited by 44 publications

References 14 publications

Electronic medical record analysis of emergency room visits and hospitalizations in individuals with epilepsy and mental illness comorbidity

Electronic medical record analysis of emergency room visits and hospitalizations in individuals with epilepsy and mental illness comorbidity

Epilepsy and hypertension: The possible link for sudden unexpected death in epilepsy?

Correlates of Stigma in People with Epilepsy

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