Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study
Introduction Epilepsy mortality rates are rising. It is unknown whether rates are rising due to an increase in epilepsy prevalence, changes in epilepsy causes of death, increase in the lethality or epilepsy or failures of treatment. To address these questions, we compare epilepsy mortality rates in...
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BMJ Publishing Group
2020-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/8/e035767.full |
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| author | Christopher M DeGiorgio Ashley Curtis Armen Carapetian Dominic Hovsepian Anusha Krishnadasan |
| author_facet | Christopher M DeGiorgio Ashley Curtis Armen Carapetian Dominic Hovsepian Anusha Krishnadasan |
| author_sort | Christopher M DeGiorgio |
| collection | DOAJ |
| description | Introduction Epilepsy mortality rates are rising. It is unknown whether rates are rising due to an increase in epilepsy prevalence, changes in epilepsy causes of death, increase in the lethality or epilepsy or failures of treatment. To address these questions, we compare epilepsy mortality rates in the USA with all-cause and all-neurological mortality for the years 1999 to 2017.Objectives To determine changes in US epilepsy mortality rates versus all-cause mortality, and to evaluate changes in the leading causes of death in people with epilepsy.Design Retrospective population-based multiple cause-of-death study.Primary outcome Change in age-adjusted epilepsy mortality rates compared with mortality rates for all-cause and all-neurological mortality.Secondary outcome Changes in the leading causes of death in epilepsy.Results From 1999 to 2017, epilepsy mortality rates in the USA increased 98.8%, from 5.83 per million in 1999 to 11.59 per million (95% CI 88.2%–110.0%), while all-cause mortality declined 16.4% from 8756.34 per million to 7319.17 per million (95% CI 16.3% to 16.6%). For the same period, all-neurological mortality increased 80.8% from 309.21 to 558.97 per million (95% CI 79.4%–82.1%). The proportion of people with epilepsy who died due to neoplasms, vascular dementia and Alzheimer’s increased by 52.3%, 210.1% and 216.8%, respectively. During the same period, the proportion who died due to epilepsy declined 27.1%, while ischaemic heart disease as a cause of death fell 42.6% (p<0.001).Conclusions Epilepsy mortality rates in the USA increased significantly from 1999 to 2017. Likely causes include increases in all-neurological mortality, increased epilepsy prevalence and changes in the underlying causes of death in epilepsy, led by increases in vascular dementia and Alzheimer’s. An important finding is that ischaemic heart disease and epilepsy itself are declining as underlying causes of death in people with epilepsy. |
| format | Article |
| id | doaj-art-efd64efa9c1b418da51174a5bcd09703 |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-efd64efa9c1b418da51174a5bcd097032025-08-20T02:50:45ZengBMJ Publishing GroupBMJ Open2044-60552020-08-0110810.1136/bmjopen-2019-035767Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death studyChristopher M DeGiorgio0Ashley Curtis1Armen Carapetian2Dominic Hovsepian3Anusha Krishnadasan4David Geffen-UCLA School of Medicine, Los Angeles, California, USADavid Geffen-UCLA School of Medicine, Los Angeles, California, USADavid Geffen-UCLA School of Medicine, Los Angeles, California, USADepartment of Neurology, Stanford University School of Medicine, Stanford, California, USAOlive View and Ronald Reagan-UCLA Medical Center Emergency Medicine, University of California - Los Angeles, Los Angeles, California, USAIntroduction Epilepsy mortality rates are rising. It is unknown whether rates are rising due to an increase in epilepsy prevalence, changes in epilepsy causes of death, increase in the lethality or epilepsy or failures of treatment. To address these questions, we compare epilepsy mortality rates in the USA with all-cause and all-neurological mortality for the years 1999 to 2017.Objectives To determine changes in US epilepsy mortality rates versus all-cause mortality, and to evaluate changes in the leading causes of death in people with epilepsy.Design Retrospective population-based multiple cause-of-death study.Primary outcome Change in age-adjusted epilepsy mortality rates compared with mortality rates for all-cause and all-neurological mortality.Secondary outcome Changes in the leading causes of death in epilepsy.Results From 1999 to 2017, epilepsy mortality rates in the USA increased 98.8%, from 5.83 per million in 1999 to 11.59 per million (95% CI 88.2%–110.0%), while all-cause mortality declined 16.4% from 8756.34 per million to 7319.17 per million (95% CI 16.3% to 16.6%). For the same period, all-neurological mortality increased 80.8% from 309.21 to 558.97 per million (95% CI 79.4%–82.1%). The proportion of people with epilepsy who died due to neoplasms, vascular dementia and Alzheimer’s increased by 52.3%, 210.1% and 216.8%, respectively. During the same period, the proportion who died due to epilepsy declined 27.1%, while ischaemic heart disease as a cause of death fell 42.6% (p<0.001).Conclusions Epilepsy mortality rates in the USA increased significantly from 1999 to 2017. Likely causes include increases in all-neurological mortality, increased epilepsy prevalence and changes in the underlying causes of death in epilepsy, led by increases in vascular dementia and Alzheimer’s. An important finding is that ischaemic heart disease and epilepsy itself are declining as underlying causes of death in people with epilepsy.https://bmjopen.bmj.com/content/10/8/e035767.full |
| spellingShingle | Christopher M DeGiorgio Ashley Curtis Armen Carapetian Dominic Hovsepian Anusha Krishnadasan Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study BMJ Open |
| title | Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study |
| title_full | Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study |
| title_fullStr | Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study |
| title_full_unstemmed | Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study |
| title_short | Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study |
| title_sort | why are epilepsy mortality rates rising in the united states a population based multiple cause of death study |
| url | https://bmjopen.bmj.com/content/10/8/e035767.full |
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