Gorton Hayley C, Webb Roger T, Parisi Rosa, Carr Matthew J, DelPozo-Banos Marcos, Moriarty Kieran J, Pickrell W Owen, John Ann, Ashcroft Darren M
School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom.
NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom.
Front Neurol. 2021 Jan 21;11:623139. doi: 10.3389/fneur.2020.623139. eCollection 2020.
The risk of dying by alcohol-specific causes in people with epilepsy has seldom been reported from population-based studies. We aimed to estimate the relative risk of alcohol-specific mortality in people with epilepsy, and the extent to which problematic alcohol use was previously identified in the patients' medical records. We delineated cohort studies in two population-based datasets, the Clinical Practice Research Datalink (CPRD GOLD) in England (January 01, 2001-December 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (January 01, 2001-December 31, 2014), linked to hospitalization and mortality records. People with epilepsy were matched to up to 20 persons without epilepsy on gender, age (±2 years) and registered general practice. We identified alcohol-specific death from Office for National Statistics (ONS) records using specified ICD-10 codes. We further identified prescriptions, interventions and hospitalisations related to alcohol use. In the CPRD GOLD, we identified 9,871 individuals in the incident epilepsy cohort and 185,800 in the comparison cohort and, in the SAIL Databank, these numbers were 5,569 and 110,021, respectively. We identified a five-fold increased risk of alcohol-specific mortality in people with epilepsy vs. those without the condition in our pooled estimate across the two datasets (deprivation-adjusted HR 4.85, 95%CI 3.46-6.79). People with epilepsy are at increased risk of dying by an alcohol-specific cause than those without the disorder. It is plausible that serious alcohol misuse could either contribute to the development of epilepsy or it could commence subsequent to epilepsy being diagnosed. Regardless of the direction of the association, it is important that the risk of dying as a consequence of alcohol misuse is accurately quantified in people affected by epilepsy. Systematically-applied, sensitive assessment of alcohol consumption by healthcare professionals, at opportunistic, clinical contacts, with rapid access to quality treatment services, should be mandatory and play a key role in reduction of health harms and mortality.
基于人群的研究很少报告癫痫患者因酒精特定原因死亡的风险。我们旨在估计癫痫患者酒精特定死亡率的相对风险，以及在患者病历中先前确定的问题饮酒程度。我们在两个基于人群的数据集（英格兰的临床实践研究数据链（CPRD GOLD）（2001年1月1日至2014年12月31日）和威尔士的安全匿名信息链接（SAIL）数据库（2001年1月1日至2014年12月31日））中进行队列研究，这些数据集与住院和死亡记录相关联。癫痫患者在性别、年龄（±2岁）和注册全科医疗方面与多达20名无癫痫患者进行匹配。我们使用指定的ICD - 10编码从国家统计局（ONS）记录中识别出酒精特定死亡。我们还进一步识别了与酒精使用相关的处方、干预措施和住院情况。在CPRD GOLD中，我们在癫痫发病队列中识别出9871人，在对照队列中识别出185800人；在SAIL数据库中，这些数字分别为5569人和110,021人。在我们对两个数据集的汇总估计中，我们发现癫痫患者酒精特定死亡率比无癫痫患者高出五倍（经贫困调整的风险比4.85，95%置信区间3.46 - 6.79）。癫痫患者因酒精特定原因死亡的风险高于无该疾病的人。严重酒精滥用可能导致癫痫的发生，或者在癫痫被诊断后开始，这似乎是合理的。无论这种关联的方向如何，准确量化受癫痫影响人群因酒精滥用导致死亡的风险都很重要。医疗保健专业人员在机会性临床接触中对酒精消费进行系统应用的敏感评估，并能快速获得优质治疗服务，应该是强制性规定，并在减少健康危害和死亡率方面发挥关键作用。
