Table 5.
Mortality risks after diagnosis with epilepsy, stratified by diagnostic threshold, sex, severity, patient type, epilepsy subtype, age group, birth order, and time after first diagnosis
|
External causes |
Suicide or uncertain |
Vehicle accidents |
Other accidents |
|||||||
|---|---|---|---|---|---|---|---|---|---|---|
| n (% deaths) | aOR (95% CI) | n (% deaths) | aOR (95% CI) | n (% deaths) | aOR (95% CI) | n (% deaths) | aOR (95% CI) | |||
| No epilepsy (n=660 869) | 2101 (42·9%) | 1·0 (ref) | 1058 (21·6%) | 1·0 (ref) | 517 (10·6%) | 1·0 (ref) | 453 (9·3%) | 1·0 (ref) | ||
| Epilepsy | ||||||||||
| Sex | ||||||||||
| Male (n=36 999) | 711 (18·8%) | 3·4 (3·1–3·8) | 346 (9·1%) | 3·3 (2·8–3·8) | 74 (2·0%) | 1·5 (1·1–2·0) | 281 (7·4%) | 5·2 (4·3–6·3) | ||
| Female (n=32 996) | 261 (11·0%) | 4·3 (3·6–5·1) | 164 (6·9%) | 5·0 (4·0–6·3) | 17 (0·7%) | 1·1 (0·6–2·1) | 81 (3·4%) | 7·2 (5·1–10·3) | ||
| Threshold | ||||||||||
| ≥1 diagnosis (n=69 995) | 972 (15·8%) | 3·6 (3·3–4·0) | 510 (8·3%) | 3·7 (3·3–4·2) | 91 (1·5%) | 1·4 (1·1–1·8) | 362 (5·9%) | 5·5 (4·7–6·5) | ||
| ≥2 diagnoses (n=48 105) | 535 (12·9%) | 3·1 (2·8–3·5) | 257 (6·2%) | 2·8 (2·4–3·4) | 55 (1·3%) | 1·5 (1·0–2·0) | 218 (5·2%) | 5·5 (4·5–6·8) | ||
| Severity | ||||||||||
| Less severe (n=62 143) | 802 (17·4%) | 3·6 (3·3–4·0) | 428 (9·3%) | 3·9 (3·4–4·4) | 77 (1·7%) | 1·6 (1·2–2·1) | 293 (6·4%) | 5·1 (4·2–6·0) | ||
| More severe (n=7852) | 170 (11·0%) | 3·4 (2·7–4·4) | 82 (5·3%) | 2·7 (1·9–3·8) | 14 (0·9%) | 0·8 (0·4–1·8) | 69 (4·5%) | 9·3 (6·0–14·5) | ||
| Source | ||||||||||
| Inpatient (n=50 071) | 887 (15·2%) | 3·7 (3·3–4·1) | 459 (7·9%) | 3·7 (3·2–4·2) | 85 (1·5%) | 1·5 (1·1–1·9) | 334 (5·7%) | 5·7 (4·8–6·8) | ||
| Outpatient only (n=19 924) | 85 (25·3%) | 3·1 (2·4–4·1) | 51 (15·2%) | 3·8 (2·7–5·4) | 6 (1·8%) | 1·0 (0·4–2·4) | 28 (8·3%) | 4·2 (2·6–7·0) | ||
| Type of seizures* | ||||||||||
| Complex partial (n=8382) | 56 (13·0%) | 2·2 (1·6–3·1) | 31 (7·2%) | 2·9 (1·8–4·5) | 6 (1·4%) | 1·2 (0·5–3·1) | 20 (4·6%) | 2·6 (1·4–4·8) | ||
| Other partial (n=5857) | 55 (15·1%) | 1·9 (1·3–2·8) | 33 (9·0%) | 1·9 (1·1–3·2) | 8 (2·2%) | 1·4 (0·6–3·3) | 15 (4·1%) | 3·1 (1·4–6·6) | ||
| Generalised (n=15 315) | 179 (12·3%) | 1·8 (1·5–2·3) | 87 (6·0%) | 1·8 (1·4–2·5) | 20 (1·4%) | 0·9 (0·5–1·6) | 69 (4·7%) | 3·1 (2·1–4·6) | ||
| Other and unspecified (n=40 441) | 682 (17·5%) | 5·1 (4·5–5·7) | 359 (9·2%) | 5·1 (4·4–6·0) | 57 (1·5%) | 1·7 (1·2–2·5) | 258 (6·6%) | 7·3 (6·0–8·9) | ||
| Type of epilepsy† | ||||||||||
| Focal (n=12 841) | 55 (9·0%) | 1·5 (1·1–2·1) | 31 (5·1%) | 2·0 (1·3–3·0) | 7 (1·1%) | 0·7 (0·3–1·7) | 19 (3·1%) | 2·0 (1·1–3·6) | ||
| Generalised (n=7593) | 24 (14·1%) | 1·4 (0·9–2·3) | 12 (7·1%) | 1·8 (0·9–3·5) | 3 (1·8%) | 0·5 (0·2–1·8) | 9 (5·3%) | 2·6 (1·1–6·0) | ||
| Encephalopathy and mixed (n=1894) | 10 (4·9%) | 2·5 (1·2–5·5) | 7 (3·4%) | 4·1 (1·5–10·8) | 1 (0·5%) | 1·0 (0·1–8·8) | 2 (1·0%) | 1·8 (0·3–9·9) | ||
| Special syndromes (n=894) | 39 (26·4%) | 9·5 (5·3–17·0) | 16 (10·8%) | 4·3 (2·0–9·3) | 1 (0·7%) | 2·7 (0·2–31·2) | 22 (14·9%) | 24·2 (9·2–63·9) | ||
| Other epilepsy (n=710) | 8 (14·8%) | 5·4 (2·1–14·4) | 0 (0·0%) | .. | 1 (1·9%) | 1·8 (0·1–24·2) | 7 (13·0%) | 12·8 (3·9–42·6) | ||
| Unspecified epilepsy (n=29 997) | 352 (16·1%) | 4·8 (4·1–5·5) | 173 (7·9%) | 4·3 (3·5–5·3) | 31 (1·4%) | 2·3 (1·5–3·6) | 139 (6·3%) | 6·9 (5·4–8·8) | ||
| Age at death | ||||||||||
| 0–15 (n=69 995) | 45 (4·0%) | 3·8 (1·9–7·6) | 7 (0·6%) | 4·7 (1·0–22·2) | 5 (0·4%) | .. | 27 (2·4%) | 5·1 (2·2–11·6) | ||
| 16–25 (n=68 877) | 135 (14·8%) | 1·8 (1·3–2·3) | 67 (7·3%) | 1·9 (1·3–2·8) | 20 (2·2%) | 0·8 (0·4–1·5) | 40 (4·4%) | 3·4 (2·0–5·6) | ||
| 26–35 (n=67 963) | 276 (21·8%) | 3·3 (2·8–4·0) | 157 (12·4%) | 3·3 (2·6–4·3) | 28 (2·2%) | 1·7 (1·1–2·8) | 95 (7·5%) | 5·3 (3·7–7·4) | ||
| 36–45 (n=66 691) | 338 (20·7%) | 4·9 (4·2–5·7) | 189 (11·6%) | 5·1 (4·2–6·3) | 20 (1·2%) | 1·6 (0·9–2·6) | 135 (8·3%) | 7·0 (5·4–9·1) | ||
| 46–56 (n=65 055) | 178 (14·6%) | 5·7 (4·7–7·0) | 90 (7·4%) | 5·5 (4·2–7·3) | 18 (1·5%) | 6·3 (3·3–12·0) | 65 (5·3%) | 6·3 (4·4–9·0) | ||
| Birth order | ||||||||||
| Firstborn (n=21 131) | 263 (14·3%) | 3·1 (2·7–3·7) | 129 (7·0%) | 3·2 (2·5–4·1) | 28 (1·5%) | 1·2 (0·8–2·0) | 107 (5·8%) | 5·2 (3·8–7·0) | ||
| Not firstborn (n=27 306) | 314 (15·3%) | 3·6 (3·1–4·2) | 169 (8·2%) | 4·0 (3·2–4·9) | 36 (1·8%) | 1·6 (1·0–2·4) | 102 (5·0%) | 4·7 (3·5–6·2) | ||
| No siblings (n=21 558) | 395 (17·4%) | 4·0 (3·4–4·7) | 212 (9·4%) | 3·7 (3·0–4·6) | 27 (1·2%) | 1·4 (0·9–2·4) | 153 (6·8%) | 6·6 (5·1–8·7) | ||
| Time period | ||||||||||
| 0–182 days (n=69 995) | 97 (10·8%) | 13·8 (9·2–20·9) | 50 (5·6%) | 17·9 (9·8–32·6) | 7 (0·8%) | 3·6 (1·0–12·5) | 39 (4·4%) | 23·5 (10·3–53·4) | ||
| 183–365 days (n=69 096) | 58 (11·5%) | 8·3 (5·3–12·9) | 36 (7·1%) | 13·0 (6·9–24·3) | 6 (1·2%) | 2·1 (0·6–7·1) | 15 (3·0%) | 10·6 (4·0–28·1) | ||
| ≥366 days (n=68 592) | 817 (17·2%) | 3·3 (3·0–3·6) | 424 (8·9%) | 3·3 (2·9–3·8) | 78 (1·6%) | 1·4 (1·0–1·8) | 308 (6·5%) | 5·2 (4·4–6·2) | ||
% deaths refers to proportion of all deaths for row category which were due to the column cause (eg, of the male deaths in epilepsy, 18·8% were from external causes). Adjusted odds ratios (aOR) report odds of mortality in individuals with epilepsy compared with general population controls (matched for age and sex, and adjusted for income, and marital and immigration statuses). Suicide category includes undetermined deaths.
Complex partial (ICD-8: 345.31; ICD-9: 345M, 345N; ICD-10: G40.2); other partial (ICD-8: 345.30, 345.38, 345.39; ICD-10: G40.0, G40.1); generalised (ICD-8: 345.00, 345.09, 345.10, 345.11; ICD-9: 345J, 345K; ICD-10: G40.3); other and unspecified (ICD-8: 345.18, 345.19, 345.20, 345.29, 345.32, 345.33, 345.9; ICD-9: 345L, 345P, 345Q, 345W, 345X; ICD-10: G40.4, G40.5, G40.6, G40.7, G40.8, G40.9, G41).
Focal (ICD-10: G40.0, G40.1, G40.2); generalised (ICD-10: G40.3); encephalopathy and mixed (ICD-10: G40.4); special syndromes (ICD-10: G40.5); other epilepsy (ICD-10: G40.8); unspecified epilepsy (ICD-10: G40.6, G40.7, G40.9).