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. 2020 Jun 16;94(24):e2555–e2566. doi: 10.1212/WNL.0000000000009463

Figure 2. Plot of estimated SUDEP incidence in the highest and lowest SES quartiles.

Figure 2

Estimated incidence of sudden unexpected death in epilepsy (SUDEP) per 1,000 patient-years is shown for New York City (red), Maryland (orange), and San Diego County (blue) medical examiner (ME) offices and adjusted overall incidence (black) for zip codes in the highest (circles) and lowest (triangle) socioeconomic status (SES) quartiles for both of the 2-year periods reviewed. Error bars represent 95% confidence intervals (CIs). Overall estimated SUDEP incidence adjusted for ME office was significantly higher in the lowest-income zip codes compared to the highest-income zip codes in 2009 to 2010 (rate ratio [RR] 2.6, 95% CI 1.7–4.1) and 2014 to 2015 (RR 3.3, 95% CI 1.9–6.0). (B) Plot of the range of SUDEP RRs and 95% CIs between the lowest and highest SES quartiles derived from probabilistic bias analysis to account for classification errors in attribution of community household income from US Census data. Results of 1 million simulations are ordered from highest to lowest RRs for 2009 to 2010 (left) and 2014 to 2015 (right). Blue circles and error bars represent observed SUDEP RRs and 95% CIs in this study. Even accounting for the imprecision of determining household income for a particular zip code using US Census data, a positive association remains between low community SES and SUDEP rate.