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Epilepsy, excess deaths and years of life lost from external causes

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Abstract

We systematically quantified excess mortality in epilepsy patients by cause of death using the population-attributable fraction and epilepsy-attributable years of potential life lost (YPLL) by age 75 years at ages 15 and over. We updated and undertook a re-review of mortality studies from our previous systematic review following PRISMA guidelines to identify cohort studies of general epilepsy populations reporting a relative risk (RR) of death by cause relative to the background rates in the population. Studies on epilepsy prevalence were identified through published reviews. Country-specific mortality figures were obtained from the WHO World Mortality Database. We performed a pooled analysis with the DerSimonian–Laird random effects method. In countries with very high Human Development Indices, epilepsy contributed to 0.5–1.1 % of all deaths in the total population. Among external causes, suicides (RR 2.9, 95 % confidence interval 2.2–3.8; I2 52 %) were the major contributor to YPLL, corresponding to 6.7 % and 4.2 % of excess YPLL due to epilepsy in the United States (US) and in the United Kingdom (UK) in 2010, with 541 (346–792) and 44 (28–65) excess suicide cases, respectively. Fatal accidental falls were more common, with 813 (610–1064) and 95 (71–125) excess deaths in the US and in the UK, but these caused only 2.0 % of excess YPLL as they occurred in older age groups. Suicides were the most important external cause of death in epilepsy patients in terms of excess YPLL, whereas other external causes were either more common in older ages or caused less excess deaths.

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Acknowledgments

There was no specific funding for this study. Previous funding sources of the study authors had no role in the design and conduct of the study.

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    Authors and Affiliations

    1. Hatanpää Health Center, Tampere, Finland

      Olli Nevalainen

    2. School of Health Sciences, University of Tampere, Tampere, Finland

      Olli Nevalainen, Jani Raitanen & Anssi Auvinen

    3. Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland

      Mikko Simola, Hanna Ansakorpi & Jouko Isojärvi

    4. UKK Institute for Health Promotion, Tampere, Finland

      Jani Raitanen

    5. Finnish Cancer Registry, Helsinki, Finland

      Miia Artama

    6. Lundbeck, Deerfield, IL, USA

      Jouko Isojärvi

    7. Pediatric Research Center, Tampere University Hospital and University of Tampere, Tampere, Finland

      Anssi Auvinen

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    Correspondence to Olli Nevalainen.

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    Conflict of interest

    Olli Nevalainen: O.N. reports grants from the Vaajasalo foundation, Eka-apuraha from the Finnish Medical Foundation, Finnish Epilepsy Research Foundation and Maire Taponen Research Foundation, a travel bursary to the 11th European Congress on Epileptology with assistance in travel expenses and accommodation (ILAE 2014), travel expenses and accommodation to an epilepsy-related teaching course organized in Finland in 2013 and 2014 (UCB Pharma). Mikko Simola:Disclosure: M.S. reports no disclosures. Hanna Ansakorpi: H.A. is a board member of the Finnish Epilepsy Association since 2010 and reports personal fees from lectures (Eisai AB, UCB, Ratiopharm Teva), travel expenses to European Congress of Epileptology 2011, Rome (Eisai AB), World Congress of Neurology 2013, Wien (Novartis Oy), and expert opinion on epilepsy treatment to the Finnish Medicines Agency in 2012. Jani Raitanen: J.R. reports no disclosures. Jouko lsojärvi: J.I. is an employee of Lundbeck, LLC. Miia Artama: M.A. reports no disclosures. Anssi Auvinen: A.A. reports no disclosures.

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    Olli Nevalainen and Mikko Simola have contributed equally to this work.

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    Nevalainen, O., Simola, M., Ansakorpi, H. et al. Epilepsy, excess deaths and years of life lost from external causes. Eur J Epidemiol 31, 445–453 (2016). https://doi.org/10.1007/s10654-015-0095-5

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