Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
Epilepsia. 2024 Aug;65(8):2354-2367. doi: 10.1111/epi.18032. Epub 2024 Jun 4.
Prior studies have examined chronic conditions in older adults with prevalent epilepsy, but rarely among those with incident epilepsy. Identifying the chronic conditions with which older adults present at epilepsy incidence assists with the evaluation of disease burden in this patient population and informs coordinated care development. The aim of this study was to identify preexisting chronic conditions with excess prevalence in older adults with incident epilepsy compared to those without.
Using a random sample of 4 999 999 fee-for-service Medicare beneficiaries aged >65 years, we conducted a retrospective cohort study of epilepsy incidence in 2019. Non-Hispanic Black and Hispanic beneficiaries were oversampled. We identified preexisting chronic conditions from the 2016-2018 Medicare Beneficiary Summary Files and compared chronic condition prevalence between Medicare beneficiaries with and without incident epilepsy in 2019. We characterized variations in preexisting excess chronic condition prevalence by age, sex, and race/ethnicity, adjusting for the racial/ethnic oversampling.
We observed excess prevalence of most preexisting chronic conditions in beneficiaries with incident epilepsy (n = 20 545, weighted n = 19 631). For stroke, for example, the adjusted prevalence rate ratio (APRR) was 4.82 (99% CI:4.60, 5.04), meaning that, compared to those without epilepsy, beneficiaries with incident epilepsy in 2019 had 4.82 times the stroke prevalence. Similarly, beneficiaries with incident epilepsy had a higher prevalence rate for preexisting neurological conditions (APRR = 3.17, 99% CI = 3.08-3.27), substance use disorders (APRR = 3.00, 99% CI = 2.81-3.19), and psychiatric disorders (APRR = 1.98, 99% CI = 1.94-2.01). For most documented chronic conditions, excess prevalence among beneficiaries with incident epilepsy in 2019 was larger for younger age groups compared to older age groups, and for Hispanic beneficiaries compared to both non-Hispanic White and non-Hispanic Black beneficiaries.
Compared to epilepsy-free Medicare beneficiaries, those with incident epilepsy in 2019 had a higher prevalence of most preexisting chronic conditions. Our findings highlight the importance of health promotion and prevention, multidisciplinary care, and elucidating shared pathophysiology to identify opportunities for prevention.
先前的研究已经调查了老年人群中普遍存在的癫痫患者的慢性疾病，但很少有研究调查新诊断癫痫患者的慢性疾病。确定新诊断癫痫患者的慢性疾病有助于评估该患者人群的疾病负担，并为协调护理的发展提供信息。本研究的目的是确定与无新发癫痫的老年人群相比，新诊断癫痫患者中慢性疾病的患病率是否过高。
我们使用了一项随机抽取的 4999999 名年龄>65 岁的医疗保险受益人的样本，开展了一项 2019 年癫痫发病率的回顾性队列研究。对非西班牙裔黑人和西班牙裔受益人的样本进行了超采样。我们从 2016-2018 年医疗保险受益人的年度总结文件中确定了慢性疾病，并比较了 2019 年有和无新发癫痫的医疗保险受益人的慢性疾病的患病率。我们根据年龄、性别和种族/族裔，调整了种族/族裔超采样的影响，描述了不同年龄、性别和种族/族裔的慢性疾病的患病率差异。
我们观察到，患有新发癫痫的患者中，大多数慢性疾病的患病率过高（n=20545，加权 n=19631）。例如，在中风方面，调整后的患病率比（APRR）为 4.82（99%CI：4.60，5.04），这意味着与无癫痫的患者相比，2019 年新发癫痫的患者中风的患病率是其 4.82 倍。同样，新发癫痫患者的神经疾病（APRR=3.17，99%CI=3.08-3.27）、物质使用障碍（APRR=3.00，99%CI=2.81-3.19）和精神障碍（APRR=1.98，99%CI=1.94-2.01）的患病率更高。对于大多数有记录的慢性疾病，与年龄较大的年龄组相比，2019 年新发癫痫患者的患病率在年龄较小的年龄组中更高，与非西班牙裔白人患者相比，与非西班牙裔黑人患者相比，西班牙裔患者的患病率更高。
与无癫痫的医疗保险受益人相比，2019 年新发癫痫的患者的大多数慢性疾病的患病率更高。我们的研究结果强调了促进健康和预防、多学科护理以及阐明共同的病理生理学的重要性，以确定预防的机会。
