Social determinants of health in epilepsy

Szaflarski, Magdalena

doi:10.1016/j.yebeh.2014.06.013

Cited by 93 publications

(78 citation statements)

References 43 publications

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“…These findings are consistent with other studies indicating that less social support is a major risk factor for morbidity as well as mortality [28]. Because people with epilepsy are more likely to never have been married than those without epilepsy [29,30], decreased social support [31] may make them more prone to psychological and physical ailments that could cause a higher risk of suicide [32]. However, overall marital status did not differ between those with and without epilepsy when we combined men and women who died from suicide.…”

Section: Discussionsupporting

confidence: 90%

Suicide among people with epilepsy: A population-based analysis of data from the U.S. National Violent Death Reporting System, 17 states, 2003–2011

Tian

Cui

Zack

et al. 2016

Epilepsy & Behavior

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Objective This study analyzed suicide data in the general population from the U.S. National Violent Death Reporting System (NVDRS) to investigate suicide burden among those with epilepsy and risk factors associated with suicide and to suggest measures to prevent suicide among people with epilepsy. Methods The NVDRS is a multiple-state, population-based, active surveillance system that collects information on violent deaths including suicide. Among people 10 years old and older, we identified 972 suicide cases with epilepsy and 81,529 suicide cases without epilepsy in 17 states from 2003 through 2011. We estimated their suicide rates, evaluated suicide risk among people with epilepsy, and investigated suicide risk factors specific to epilepsy by comparing those with and without epilepsy. In 16 of the 17 states providing continual data from 2005 through 2011, we also compared suicide trends in people with epilepsy (n = 833) and without epilepsy (n = 68,662). Results From 2003 through 2011, the estimated annual suicide mortality rate among people with epilepsy was 16.89/100,000 per persons, 22% higher than that in the general population. Compared with those without epilepsy, those with epilepsy were more likely to have died from suicide in houses, apartments, or residential institutions (81% vs. 76%, respectively) and were twice as likely to poison themselves (38% vs. 17%) (P < 0.01). More of those with epilepsy aged 40–49 died from suicide than comparably aged persons without epilepsy (29% vs. 22%) (P < 0.01). The proportion of suicides among those with epilepsy increased steadily from 2005 through 2010, peaking significantly in 2010 before falling. Significance For the first time, the suicide rate among people with epilepsy in a large U.S. general population was estimated, and the suicide risk exceeded that in the general population. Suicide prevention efforts should target people with epilepsy 40–49 years old. Additional preventive efforts include reducing the availability or exposure to poisons, especially at home, and supporting other evidence-based programs to reduce mental illness comorbidity associated with suicide.

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Section: Discussionsupporting

confidence: 90%

Suicide among people with epilepsy: A population-based analysis of data from the U.S. National Violent Death Reporting System, 17 states, 2003–2011

Tian

Cui

Zack

et al. 2016

Epilepsy & Behavior

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“…This is a unique finding, because many chronic neurologic disorders are associated with a downward socioeconomic drift. Socioeconomic downward drifts have been well documented in neurologic diseases like epilepsy, migraines, and multiple sclerosis . These conditions are associated with marked disability, leading to numerous hospitalizations, lack of work productivity, loss of work days, and even unemployment, eventually leading to a fall to a lower socioeconomic quartile than at the time of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Hospitalizations of Children with Huntington's Disease in the United States

Mendizabal

Thibault

et al. 2017

Movement Disord Clin Pract

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Background Juvenile Huntington's disease (JHD) is a childhood‐onset neurodegenerative disorder. Although it is caused by the same pathologic expansion of CGA repeats as adult‐onset Huntington's disease, JHD has distinct clinical features. Most clinical research in HD focuses in the adult‐onset disease; therefore, little is known about acute care outcomes for patients with JHD. Methods The Kids' Inpatient Database (KID) was used to examine hospitalizations of children with JHD and to determine the diagnoses and procedures associated with inpatient care for JHD. Regression models were built to examine acute care outcomes, including death, length of stay, and disposition at discharge in patients with JHD compared with patients in the general KID data. Results The proportion of JHD cases among hospitalized children was 1.23 per 100,000 KID inpatient stays. Seizures/convulsions (58.5%) and psychiatric conditions (26.1%) were the most common primary or secondary diagnoses among JHD patient hospitalizations. The most common procedure was percutaneous endoscopic gastrostomy tube placement (8.6%). Compared with hospitalizations of the general population, hospitalizations of patients with JHD had a lower odds of discharge to home (adjusted odds ratio [AOR], 0.23; 95% confidence interval [CI], 0.14–0.37) and an increased likelihood of death (AOR, 8.03; 95% CI, 2.98–21.60) or discharge to a short‐term care facility (AOR, 4.44; 95% CI, 2.59–7.61). A diagnosis of JHD was associated with increased length of stay (7.04 vs. 3.75 days; P < 0.01). Conclusions Children with JHD have unique acute care patterns. Future studies are needed to determine the extent to which coordinated care may impact inpatient and disposition needs.

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“…Although a number of earlier studies investigated access to epilepsy treatments and availability of AEDs in different regions, this is to our knowledge the first systematic study on the availability of AEDs in Europe. The results show large differences in the availability of AEDs across countries, which concern especially, but not exclusively, the most recent medications.…”

Section: Discussionmentioning

confidence: 99%

Availability of antiepileptic drugs across Europe

et al. 2015

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SUMMARYEurope consists of 53 countries with widely different economic conditions and different political, educational, and health care systems. This study was aimed at determining the availability of antiepileptic drugs (AEDs) across Europe. An electronic questionnaire was submitted to all 43 European chapters of the International League Against Epilepsy (ILAE). Outcome measures were availability of older, newer, and newest AEDs, generic products, indications, reimbursement rules, and reasons for lack of availability of AEDs. Countries were divided according to economic status as defined by the World Bank. Thirty-four chapters (79%) provided data. There were large differences in AED availability across countries, especially between high-income countries and the other countries. The newest AEDs were not available in any of the 12 nonhigh-income countries. Availability was higher in countries with public reimbursement systems. Reimbursement policies ranged from full reimbursement for all AEDs to complete lack of reimbursement. Main hurdles for poor access to AEDs included lack of regulatory approval, high prices and reimbursement restrictions. The availability of AEDs differs across European countries, with many hurdles hampering access to epilepsy medicines, particularly to new medications. These findings raise major concerns on the quality of epilepsy care in many countries.

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Social determinants of health in epilepsy

Cited by 93 publications

References 43 publications

Suicide among people with epilepsy: A population-based analysis of data from the U.S. National Violent Death Reporting System, 17 states, 2003–2011

Suicide among people with epilepsy: A population-based analysis of data from the U.S. National Violent Death Reporting System, 17 states, 2003–2011

Hospitalizations of Children with Huntington's Disease in the United States

Availability of antiepileptic drugs across Europe

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