Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Epilepsia. 2020 Apr;61(4):714-724. doi: 10.1111/epi.16465. Epub 2020 Feb 27.
Individuals with epilepsy have poor bone development and preservation throughout the lifespan and are vulnerable to nontrauma fracture (NTFx) and post-NTFx complications. However, no studies have examined the contribution of NTFx to mortality among adults with epilepsy. The objective was to determine whether NTFx is a risk factor for mortality among adults with epilepsy.
Data from 2011 to 2016 were obtained from Optum Clinformatics Data Mart, a nationwide claims database from a single private payer in the United States. Diagnosis codes were used to identify adults (≥18 years old) with epilepsy, NTFx, and covariates (demographics and pre-NTFx cardiovascular disease, respiratory disease, diabetes, chronic kidney disease, cancer). Crude mortality rate per 100 person-years was estimated. Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) were determined for mortality, comparing epilepsy and NTFx (EP + NTFx; n = 11 471), epilepsy without NTFx (EP without NTFx; n = 50 384), without epilepsy and with NTFx (without EP + NTFx; n = 423 041), and without epilepsy and without NTFx (without EP without NTFx; n = 6.8 million) after adjusting for covariates.
The 3-, 6-, and 12-month crude mortality rates were highest among EP + NTFx (12-month mortality rate = 8.79), followed by without EP + NTFx (12-month mortality rate = 4.80), EP without NTFx (12-month mortality rate = 3.06), and without EP without NTFx (12-month mortality rate = 0.47). After adjustments, the mortality rate was elevated for EP + NTFx for all time points compared to EP without NTFx (eg, 12-month HR = 1.70, 95% CI = 1.58-1.85), without EP + NTFx (eg, 12-month HR = 1.41, 95% CI = 1.32-1.51), and without EP without NTFx (eg, 12-month HR = 5.23, 95% CI = 4.88-5.60). Stratified analyses showed higher adjusted HRs of 12-month mortality for EP + NTFx for all NTFx sites (ie, vertebral column, hip, extremities), all age categories (young, middle-aged, older), and for both women and men.
Among adults with epilepsy and compared to adults without epilepsy, NTFx is associated with a higher 12-month mortality rate. Findings suggest that NTFx may be a robust risk factor for mortality among adults with epilepsy.
癫痫患者在整个生命周期中都存在骨骼发育不良和骨骼丢失的问题，易发生非创伤性骨折（NTFx）和骨折后并发症。但是，目前尚无研究探讨 NTFx 是否是癫痫患者死亡的危险因素。本研究旨在确定 NTFx 是否是癫痫患者死亡的危险因素。
数据来源于 2011 年至 2016 年 Optum Clinformatics Data Mart，这是美国一家私人支付方的全国性索赔数据库。使用诊断代码识别年龄≥18 岁的癫痫、NTFx 患者和协变量（人口统计学和骨折前心血管疾病、呼吸系统疾病、糖尿病、慢性肾脏病、癌症）。估计每 100 人年的粗死亡率。采用 Cox 回归估计死亡率的风险比（HR）和 95%置信区间（CI），比较癫痫伴 NTFx（EP+NTFx；n=11471）、癫痫无 NTFx（EP 无 NTFx；n=50384）、无癫痫伴 NTFx（无 EP+NTFx；n=423041）和无癫痫无 NTFx（无 EP 无 NTFx；n=680 万）患者的死亡率，同时调整了协变量。
EP+NTFx 的 3 个月、6 个月和 12 个月的粗死亡率最高（12 个月死亡率=8.79%），其次是无 EP+NTFx（12 个月死亡率=4.80%）、EP 无 NTFx（12 个月死亡率=3.06%）和无 EP 无 NTFx（12 个月死亡率=0.47%）。调整后，与 EP 无 NTFx 相比，EP+NTFx 各时间点的死亡率均升高（例如，12 个月 HR=1.70，95%CI=1.58-1.85），与无 EP+NTFx 相比（例如，12 个月 HR=1.41，95%CI=1.32-1.51），与无 EP 无 NTFx 相比（例如，12 个月 HR=5.23，95%CI=4.88-5.60）。分层分析显示，EP+NTFx 在所有 NTFx 部位（即脊柱、髋关节、四肢）、所有年龄组（青年、中年、老年）和男性和女性中，12 个月死亡率的调整后 HR 更高。
在癫痫患者中，与无癫痫患者相比，NTFx 与更高的 12 个月死亡率相关。研究结果表明，NTFx 可能是癫痫患者死亡的一个强有力的危险因素。
