社会经济差异与母体癫痫妊娠中抗癫痫药物的使用：基于北欧全民医疗保健系统的一项研究。

Finnish Institute for Health and Welfare, Knowledge Brokers, Helsinki, Finland.

Department of Neurology, Aarhus University Hospital, Affiliated Member of the European Reference Network EpiCARE, Aarhus, Denmark.

Epilepsia. 2024 Aug;65(8):2397-2411. doi: 10.1111/epi.18022. Epub 2024 May 28.

OBJECTIVE

Research points to disparities in disease burden and access to medical care in epilepsy. We studied the association between socioeconomic status (SES) and antiseizure medication (ASM) use in pregnancies with maternal epilepsy.

METHODS

We conducted a cross-sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006-2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%-4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference.

RESULTS

Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03-1.57) to aRR = 1.66 for low education (95% CI: 1.30-2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88-2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29-2.24) and in polytherapy (aRR 2.65; 95% CI 1.66-4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08-1.26) to 1.26 (not married or cohabiting; 95% CI 1.17-1.36).

SIGNIFICANCE

Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care.

目的

研究指出癫痫患者的疾病负担和医疗服务获取存在差异。我们研究了社会经济地位（SES）与妊娠合并癫痫女性抗癫痫药物（ASM）使用之间的关系。

方法

我们进行了一项横断面研究，纳入了 2006 年至 2017 年期间从北欧登记处确定的 21130 例妊娠合并癫痫母亲。SES 指标包括同居状况、移民背景、教育程度和家庭收入。主要结局是从妊娠前 90 天到分娩时 ASM 使用的比例和模式。我们应用多重插补处理 SES 变量缺失率为 2%-4%的数据。我们采用校正泊松回归估计调整后的风险比（aRR）和 95%置信区间（CI），并以最高 SES 类别为参考。

结果

受教育程度最高和收入最高五分位数的母亲使用 ASM 的频率最低（分别为 56%和 53%）。我们观察到 SES 较低的母亲在妊娠前或妊娠早期停用 ASM 的风险增加。SES 指标的风险估计值因指标而异，收入较低的 aRR 值为 1.27（95%CI：1.03-1.57），教育程度较低的 aRR 值为 1.66（95%CI：1.30-2.13）。移民背景与妊娠第一季度后开始使用 ASM 相关（aRR 2.17；95%CI 1.88-2.52）。教育程度较低与妊娠期间单药治疗（aRR 1.70；95%CI 1.29-2.24）和多药治疗（aRR 2.65；95%CI 1.66-4.21）时使用丙戊酸相关。教育程度较低还与从一种 ASM 转换为另一种 ASM 的风险增加 37%-39%相关，具体取决于使用的 ASM。对于其他 SES 指标，转换的 aRR 值从 1.16（外国血统；95%CI 1.08-1.26）到 1.26（未婚或同居；95%CI 1.17-1.36）不等。