Premature mortality in poor health and low income adults with epilepsy

Abstract

SUMMARY Objective To examine mortality and causes of death (COD) in socioeconomically disadvantaged persons with epilepsy (PWE) in the US. Methods We performed a retrospective open cohort analysis using Ohio Medicaid claims data between 1992 and 2008 to assess mortality and COD in 68,785 adult Medicaid beneficiaries with epilepsy. Case fatality (CF), mortality rates (MRs), standardized mortality ratios (SMRs), and years of potential life lost (YPLL) were calculated. The SMRs were estimated to compare risk of death in PWE with that in the general Medicaid population with and without disabilities. Proportionate mortality ratios (PMRs), YPLLs, and SMRs for specific COD were also obtained. Results There were 12,630 deaths in PWE. CF was 18.4%, the age-race-sex adjusted MR was 18.6/1,000 person-years (95% CI, 18.3–18.9). The SMR was 1.8 (95% CI, 1.8 – 1.9) when compared to the general Medicaid population, and was 1.4 (95% CI, 1.3–1.6) when compared to those with disabilities. The average YPLL was 16.9 years (range, 1–47 years). Both epilepsy and comorbid conditions significantly contributed to premature mortality in PWE. Cardiovascular diseases, cancer, and unintentional injuries were the most common COD and account for a large proportion of YPLL. Deaths from epilepsy-related causes occurred in about 10% of the cases. Significance Socioeconomically deprived PWE, especially young adults, experience high mortality and die 17 years prematurely. The high mortality in Medicaid beneficiaries with epilepsy affirms that comorbid conditions and epilepsy play a crucial role in premature death. Management of comorbid conditions is, at a minimum, as important as epilepsy management, and therefore deserves more attention from physicians, particularly those who care for Medicaid individuals with epilepsy.

Epilepsy in Asia: Disease burden, management barriers, and challenges

“…66 Several Western studies have reported lower SMRs than in Asia. In the USA, the SMR of socioeconomically deprived patients with epilepsy was 1.8, 67 and two European studies found overall SMRs of 1.7-2.2 compared with the general population of the same geographic area. 56,57 Seizure-related causes of death, especially nonvehicle accidents, 63 played a greater role in the higher mortality of Asian people with epilepsy than in Western studies, indicating the importance of seizure control to prevent premature death.…”

“…A recent Hong Kong study found a standardized mortality ratio (SMR) of 5.09 among newly diagnosed patients with epilepsy . The SMR was higher among patients with baseline physical and/or psychiatric comorbidity and highest for those with both physical and psychiatric comorbidities (Table ) . Two studies from Taiwan found SMRs for patients with epilepsy of 2.5 and 3.47, with the age‐specific SMRs being highest for boys and young women .…”

“…Several Western studies have reported lower SMRs than in Asia. In the USA, the SMR of socioeconomically deprived patients with epilepsy was 1.8, and two European studies found overall SMRs of 1.7‐2.2 compared with the general population of the same geographic area …”

“…48 The SMR was higher among patients with baseline physical and/or psychiatric comorbidity and highest for those with both physical and psychiatric comorbidities (Table 4). 48,56,57,[59][60][61][62][63][64][65][66][67][68] Two studies from Taiwan found SMRs for patients with epilepsy of 2.5 and 3.47, 60,61 with the age-specific SMRs being highest for boys and young women. 60 In rural China, premature death in people with epilepsy was 3 times that of the general population, 62 with cause-specific SMRs being significantly elevated for drowning (39.0).…”

National Association of Medical Examiners position paper: Recommendations for the investigation and certification of deaths in people with epilepsy

“…Among United States young adults with epilepsy and low socioeconomic status, deaths occur 17 years prematurely. 6 …”