Primary care electronic medical records can be used to predict risk and identify potentially modifiable factors for early and late death in adult onset epilepsy

Hrabok, Marianne; Engbers, Jordan D. T.; Wiebe, Samuel; Sajobi, Tolulope T.; Subota, Ann; Almohawes, Amal; Federico, Paolo; Hanson, Alexandra; Klein, Karl Martin; Peedicail, Joseph; Pillay, Neelan; Singh, Sumit; Josephson, Colin B.

doi:10.1111/epi.16738

Cited by 11 publications

(18 citation statements)

References 32 publications

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“… 9 – 11 Based on different diseases and risk factors, many studies have defined early death. 27 – 29 Using a definition of early death that is too long or short is not conducive for clinicians to provide effective treatment. Therefore, we defined early death as a survival time ≤7 months.…”

Section: Discussionmentioning

confidence: 99%

A predictive web-based nomogram for the early death of patients with lung adenocarcinoma and bone metastasis: a population-based study

Wei

Cao

et al. 2021

J Int Med Res

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Objective To identify risk factors and develop predictive web-based nomograms for the early death of patients with bone metastasis of lung adenocarcinoma (LUAD). Methods Patients in the Surveillance, Epidemiology, and End Results database diagnosed with bone metastasis of LUAD between 2010 and 2016 were included and randomly divided into training and validation sets. Early death-related risk factors (survival time ≤7 months) were evaluated by logistic regression. Two predictive nomograms were established and validated by calibration curves, receiver operating characteristic curves, and decision curve analysis. Results A total of 9189 patients (56.59%) died from all causes within 7 months of being diagnosed, including 8585 patients (56.67%) who died from cancer-specific causes. Age >65 years, sex (men), T stage (T3 and T4), N stage (N2 and N3), brain metastasis, and liver metastasis were risk factors for all-cause and cancer-specific early death. The area under the curves of the nomograms for all-cause and cancer-specific early death prediction were 0.754 and 0.753 (training set) and 0.747 and 0.754 (validation set), respectively. Further analysis showed that the two nomograms performed well. Conclusions Our two web-based nomograms for all-cause and cancer-specific early death provide valuable tools for predicting early death in these patients.

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Section: Discussionmentioning

confidence: 99%

A predictive web-based nomogram for the early death of patients with lung adenocarcinoma and bone metastasis: a population-based study

Wei

Cao

et al. 2021

J Int Med Res

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“…ASMs, and in particular ASM polytherapy, have been demonstrated to be protective against sudden unexpected death in epilepsy (SUDEP) 24,25 and allcause mortality. 26 These unique phenotypes affirm the ILAE's approach of including comorbidities in the classification of the epilepsies. The interactions between comorbid conditions, epilepsy onset, and premature mortality are complex and important for prognosticating disease progression.…”

Section: Discussionmentioning

confidence: 79%

“… a Determined using a validated risk prediction model for early death (<4 years from diagnosis) in adult onset epilepsy 26 …”

Section: Methodsmentioning

confidence: 99%

“…ASM, antiseizure medication; COPD, chronic obstructive pulmonary disease; CRF, chronic renal failure; HIV, human immunodeficiency virus; IQR, interquartile range; MVC, motor vehicle collision; PVD, peripheral vascular disease; SMR, standardized mortality ratio.Determined using a validated risk prediction model for early death (<4 years from diagnosis) in adult onset epilepsy 26. b Age-and sex-adjusted SMR that compares all UK deaths over a 3-year period(2010)(2011)(2012) to the actual number dying over the first 4 years from their epilepsy diagnosis in the Health Improvement Network cohort.…”

mentioning

confidence: 99%

“…Abbreviations: ASM, antiseizure medication; COPD, chronic obstructive pulmonary disease; CRF, chronic renal failure; HIV, human immunodeficiency virus; IQR, interquartile range; MVC, motor vehicle collision; PVD, peripheral vascular disease. a Determined using a validated risk prediction model for late death (≥4 years from diagnosis) in adult onset epilepsy 26. …”

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confidence: 99%

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Adult onset epilepsy is defined by phenotypic clusters with unique comorbidities and risks of death

Josephson

Engbers²,

Sajobi

et al. 2021

Epilepsia

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Objective This study was undertaken to identify clusters of adult onset epilepsy with distinct comorbidities and risks of early and late death. Methods This was a retrospective open cohort study that included all adults meeting a case definition for epilepsy after the Acceptable Mortality Recording date in the Health Improvement Network database for the years 2000–2012 inclusive. Unsupervised agglomerative hierarchical clustering was performed to identify unique clusters of patients based on their predicted risk of early (<4 years of epilepsy diagnosis) and late (≥4 years from diagnosis) mortality and patient‐level clinical characteristics. Results We identified 10 499 presumed incident cases of epilepsy from 11 194 182 patients. Four phenotypic clusters were identified in the early and late risk periods. Early clusters include older adults with cardiovascular disease and a high risk of death (median predicted risk = 20%, interquartile range [IQR] = 9%–31%), a group with moderate risk of death and cancer (median predicted risk = 6%, IQR = 2%–15%), a group with psychiatric disease/substance use and few somatic comorbidities (median predicted risk = 5%, IQR = 2%–9%), and one with a younger age at onset and few comorbidities (median predicted risk = 4%, IQR = 1%–11%). There was minimal movement of individuals between clusters for those surviving the early risk period. Age‐ and sex‐standardized 3‐year mortality ratios were more than sixfold higher than the general population for every cluster, even those primarily comprised of healthy younger adults. Significance Adult onset epilepsy is marked by unique clusters of comorbid conditions and elevated risks of death that form discrete populations for targeted therapeutic interventions. These clusters remain relatively stable between the early and late mortality risk periods. Of particular interest are the clusters marked by young and otherwise healthy adults whose standardized mortality ratio is sixfold higher than general population despite few conventional risk factors for premature death.

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Equity and the JAMA Network

Fontanarosa¹,

Flanagin

Ayanian

et al. 2021

JAMA Neurol

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The key objective of JAMA is "To promote the science and art of medicine and the betterment of the public health"; similar objectives and mission statements are supported by all 12 JAMA Network Journals. Together this family of journals is committed to publishing the best research, reviews, and opinion articles to advance medical science, promote public health, and improve patient care. The ultimate goal is to promulgate truth in science and medicine.On February 23, 2021, a podcast titled "Structural Racism for Doctors-What Is It?" was posted by the JAMA Network and on the following day, a tweet was posted to promote the podcast. Assertions in both that disavowed the presence of structural racism in medicine and among physicians were wrong, misguided, and uninformed. An extensive evidence base strongly supports the presence of structural racism in medicine and its adverse influence on health. 1 The process for reviewing and publishing the podcast and tweet was also flawed. On March 4, 2021, Howard Bauchner, MD, editor in chief of JAMA and the 12 JAMA Network Journals, took responsibility and issued an apology for the podcast and tweet. This editorial team also expresses a profound apology for the misinformation in the podcast and tweet and recognizes the hurt, anger, and outrage that resulted.These events and developments make it clear that JAMA and the JAMA Network Journals can and must do better and advance toward inclusion and antiracism in all journalrelated activities. Even though these journals have made progress, additional commitment and work are needed to build on and intensify these efforts to achieve meaningful, sustainable change. For instance, previous efforts include the more than 650 research, review, and opinion articles on race, racism, and racial and ethnic disparities and inequities that have been published in JAMA and the JAMA Network Journals since 2015, 1 including editorials in JAMA on topics such as race and medical research, 2 race and poverty and medicine, 3 enhancing diversity in medical schools, 4 and equity related to COVID-19 vaccines. 5 In addition, within the past year, JAMA Network Open and JAMA Health Forum issued calls for manuscripts on prevention and effects of systemic racism in health 6,7 ; JAMA Psychiatry initiated an editorial fellowship prioritized to early-career academic psychiatrists from underrepresented backgrounds; and JAMA Surgery issued a "Call to Action" to all surgery journal editors for diversity in the editorial and peer review process. 8 The JAMA editors and editorial staff also began a thorough revision of guidance for authors and editors on reporting race and ethnicity in medical journals and earlier this year issued a wide call for feedback. 9 The journals had been chargedOpinion Editorial

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Primary care electronic medical records can be used to predict risk and identify potentially modifiable factors for early and late death in adult onset epilepsy

Cited by 11 publications

References 32 publications

A predictive web-based nomogram for the early death of patients with lung adenocarcinoma and bone metastasis: a population-based study

A predictive web-based nomogram for the early death of patients with lung adenocarcinoma and bone metastasis: a population-based study

Adult onset epilepsy is defined by phenotypic clusters with unique comorbidities and risks of death

Equity and the JAMA Network

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