Epilepsy and the risk of COVID‐19‐related hospitalization and death: A population study

Abstract

ObjectivePeople with epilepsy (PWE) may be at an increased risk of severe COVID‐19. It is important to characterize this risk to inform PWE and for future health and care planning. We assessed whether PWE were at higher risk of being hospitalized with, or dying from, COVID‐19.MethodsWe performed a retrospective cohort study using linked, population‐scale, anonymized electronic health records from the SAIL (Secure Anonymised Information Linkage) databank. This includes hospital admission and demographic data for the complete Welsh population (3.1 million) and primary care records for 86% of the population. We identified 27 279 PWE living in Wales during the study period (March 1, 2020 to June 30, 2021). Controls were identified using exact 5:1 matching (sex, age, and socioeconomic status). We defined COVID‐19 deaths as having International Classification of Diseases, 10th Revision (ICD‐10) codes for COVID‐19 on death certificates or occurring within 28 days of a positive SARS‐CoV‐2 polymerase chain reaction (PCR) test. COVID‐19 hospitalizations were defined as having a COVID‐19 ICD‐10 code for the reason for admission or occurring within 28 days of a positive SARS‐CoV‐2 PCR test. We recorded COVID‐19 vaccinations and comorbidities known to increase the risk of COVID‐19 hospitalization and death. We used Cox proportional hazard models to calculate hazard ratios.ResultsThere were 158 (.58%) COVID‐19 deaths and 933 (3.4%) COVID‐19 hospitalizations in PWE, and 370 (.27%) deaths and 1871 (1.4%) hospitalizations in controls. Hazard ratios for COVID‐19 death and hospitalization in PWE compared to controls were 2.15 (95% confidence interval [CI] = 1.78–2.59) and 2.15 (95% CI = 1.94–2.37), respectively. Adjusted hazard ratios (adjusted for comorbidities) for death and hospitalization were 1.32 (95% CI = 1.08–1.62) and 1.60 (95% CI = 1.44–1.78).SignificancePWE are at increased risk of being hospitalized with, and dying from, COVID‐19 when compared to age‐, sex‐, and deprivation‐matched controls, even when adjusting for comorbidities. This may have implications for prioritizing future COVID‐19 treatments and vaccinations for PWE.

Hospital outcomes of acute COVID-19 infection among patients with neurological conditions: a single-center study

“…Moreover, we found that having a diagnosis of epilepsy/seizure or headache carried a lower risk of death in multivariable analyses. This is different from prior studies that found an increased risk of death among people with epilepsy and COVID-19 infection compared to people without COVID-19 (a hazard ratio of 2.15 [95% CI 1.78–2.59]) ( 21 ). However, two other studies did not demonstrate an increased risk of in-hospital death among people with epilepsy and COVID-19 infection ( 22 , 23 ).…”

Health care utilization and mortality for people with epilepsy during COVID‐19: A population study

“…As part of the COVID-19 and Epilepsy in Wales (CoVEW) project, we have previously shown an increased COVID-19 vaccine uptake in PWE and a small increased risk of COVID-19 hospitalizations and deaths for PWE in Wales. 6,17 In a previous study on epilepsy deaths at the beginning of the pandemic (to the end of 2020), we found When removing COVID deaths, RRs were .88 (95% CI = .81-.95) and 1.29 (95% CI = 1.08-1.53). Status epilepticus rates did not change significantly during the pandemic (RR = .95, 95% CI = .78-1.15).…”

“…This is despite the slightly increased risk of COVID-related deaths in PWE. 6 All-cause deaths (excluding COVID-19 deaths) for PWE (and the whole Welsh population) reduced during the pandemic. This reduction in non-COVID-19 deaths during the pandemic has been found in other (but not all) populations.…”

“…1,2 There is increasing evidence that people with epilepsy (PWE) are more susceptible to severe COVID-19, having an increased risk of being hospitalized with, or dying from, COVID-19. [3][4][5][6] Significant changes in global health care provision and behavior, from the onset of the COVID-19 pandemic in early 2020, have affected people with many conditions, including epilepsy. 7 Health care professionals providing epilepsy care were redeployed to COVID-19 work, and epilepsy consultations and investigations were canceled.…”