Epilepsy Service, Department of Neurology, Cork University Hospital, Cork, Ireland.
School of Medicine, University College Cork, Cork, Ireland.
Epilepsia. 2022 Aug;63(8):2108-2119. doi: 10.1111/epi.17313. Epub 2022 Jun 10.
Epidemiologic studies have investigated whether social deprivation is associated with a higher incidence of epilepsy, and results are conflicting, especially in children. The mechanisms underlying a potential association are unclear. This study examines whether there is an association between social deprivation and the incidence of first seizures (unprovoked and provoked) and new diagnosis of epilepsy by comparing incidence across an area-level measure of deprivation in a population-based cohort.
Multiple methods of case identification followed by individual case validation and classification were carried out in a defined geographical area (population 542 868) to identify all incident cases of first provoked and first unprovoked seizures and new diagnosis of epilepsy presenting during the calendar year 2017. An area-level relative deprivation index, based on 10 indicators from census data, was assigned to each patient according to registered address and categorized into quintiles from most to least deprived.
The annual incidence of first unprovoked seizures (n = 372), first provoked seizures (n = 189), and new diagnosis of epilepsy (n = 336) was highest in the most deprived areas compared to the least deprived areas (incidence ratios of 1.79 [95% confidence interval (CI) = 1.26-2.52], 1.55 [95% CI = 1.04-2.32], and 1.83 [95% CI = 1.28-2.62], respectively). This finding was evident in both adults and children and in those with structural and unknown etiologies of epilepsy.
The incidence of first seizures and new diagnosis of epilepsy is associated with more social deprivation. The reason for this higher incidence is likely multifactorial.
流行病学研究已经调查了社会剥夺是否与癫痫发病率升高有关，结果存在争议，尤其是在儿童中。潜在关联的机制尚不清楚。本研究通过比较一个基于人口的队列中区域水平剥夺指标的发病率，来研究社会剥夺与首次发作（无诱因和有诱因）和新诊断癫痫的发病率之间是否存在关联。
在一个确定的地理区域（人口 542868 人）中，采用多种病例识别方法，随后进行个体病例验证和分类，以确定 2017 年全年无诱因和有诱因的首次发作以及新诊断癫痫的所有发病病例。根据登记地址，为每位患者分配一个基于人口普查数据的 10 项指标的区域水平相对剥夺指数，并根据最贫困到最富裕的五分位数进行分类。
与最贫困地区相比，最贫困地区的首次无诱因发作（n=372）、首次有诱因发作（n=189）和新诊断癫痫（n=336）的年发病率最高（发病率比分别为 1.79[95%置信区间（CI）=1.26-2.52]、1.55[95%CI=1.04-2.32]和 1.83[95%CI=1.28-2.62]）。这一发现无论是在成年人还是儿童中，还是在结构性和不明原因癫痫患者中都存在。
首次发作和新诊断癫痫的发病率与社会剥夺程度有关。这种更高发病率的原因可能是多因素的。
