Zhou Xiaowen, Ding Ding, Wang Wenzhi, Zhou Dong, Sander Josemir W
Institute of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China,
Institute of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Neuroepidemiology. 2025;59(4):391-404. doi: 10.1159/000540426. Epub 2024 Jul 29.
Premature mortality is a significant part of the epilepsy burden and may vary across populations, especially between high-income and lower- and middle-income countries. People with epilepsy in China are approximately a fifth of the global population with epilepsy. Previous studies were unlikely to represent the situation in China due to limitations in design, methods, sample size, follow-up time, and other inherent population heterogeneity.
By summarising the evidence on the mortality characteristics in Chinese populations with epilepsy in the last 6 decades, we found a median mortality rate of 14.7 (6.8-74.4)/1,000 person-years and a median standardised mortality ratio (SMR) of 4.4 (2.6-12.9) in population-based studies, and a median mortality rate of 12.3 (9.5-101.5)/1,000 person-years and a median SMR of 3.0 (1.5-5.1) in hospital-based studies. Vascular diseases, complications of diabetes, and accidental injuries were the leading causes of death. Risk factors for mortality were reported as older age, male, longer duration, and higher frequency of seizures. Case fatality ratios of status epilepticus in adults were higher than in children, and both increased with follow-up time. Mortality in people with symptomatic epilepsy was high and varied across different primary diseases.
The highest mortality rate and sudden unexpected death in epilepsy (SUDEP) incidence were reported from the least developed areas in China. Accidental injuries were the most common causes of epilepsy-related deaths, while the incidence of SUDEP may be underestimated in Chinese populations. Further research is warranted to improve the understanding of premature mortality risk so that preventative measures can be introduced to improve the situation.
过早死亡是癫痫负担的重要组成部分，且在不同人群中可能存在差异，尤其是在高收入国家与低收入和中等收入国家之间。中国的癫痫患者约占全球癫痫患者总数的五分之一。由于设计、方法、样本量、随访时间以及其他固有群体异质性方面的限制，以往的研究不太可能代表中国的实际情况。
通过总结过去60年中国癫痫患者群体死亡率特征的相关证据，我们发现在基于人群的研究中，中位死亡率为14.7（6.8 - 74.4）/1000人年，中位标准化死亡率（SMR）为4.4（2.6 - 12.9）；在基于医院的研究中，中位死亡率为12.3（9.5 - 101.5）/1000人年，中位SMR为3.0（1.5 - 5.1）。血管疾病、糖尿病并发症和意外伤害是主要死因。据报告，死亡风险因素包括年龄较大、男性、病程较长以及癫痫发作频率较高。成人癫痫持续状态的病死率高于儿童，且两者均随随访时间增加。症状性癫痫患者的死亡率较高，且因不同原发性疾病而异。
中国最不发达地区报告的癫痫死亡率最高，癫痫猝死（SUDEP）发生率也最高。意外伤害是癫痫相关死亡最常见的原因，而中国人群中SUDEP的发生率可能被低估。有必要进一步开展研究，以增进对过早死亡风险的理解，从而采取预防措施改善现状。
