Choi Hyunmi, Thacker Evan L, Liu Minghua, Strobino Kevin, Misiewicz Sylwia, Rundek Tatjana, Elkind Mitchell S V, Gutierrez Jose D
Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Department of Public Health, Brigham Young University, Provo, Utah, USA.
Epilepsia. 2024 Dec;65(12):3561-3570. doi: 10.1111/epi.18156. Epub 2024 Oct 15.
Little is known about the incidence of late onset epilepsy (LOE) across different racial/ethnic groups in the USA, particularly in the Hispanic population. Stroke, a strong predictor of LOE, is more common in non-Hispanic Blacks (NHBs) and Hispanics than in non-Hispanic Whites (NHWs). We assessed the incidence of LOE across racial/ethnic groups and examined whether the associations of stroke with LOE risk differ by race/ethnicity.
The Northern Manhattan Study is a population-based longitudinal study of older adults enrolled between 1993 and 2001. Participants free of history of stroke or epilepsy at baseline (n = 3419) were followed prospectively for incidence of LOE. We estimated LOE incidence per 1000 person-years in each racial/ethnic group. We used Cox proportional hazards regression to assess the association of race/ethnicity with LOE and multiplicative interactions of race/ethnicity with incident stroke in relation to LOE, adjusting for demographics and comorbid diagnoses.
During 51 176 person-years of follow-up, 183 individuals developed LOE. Incidence of LOE was significantly higher in NHBs (6.2 per 1000 person-years) than in NHWs (3.3 per 1000 person-years, p = .004). There was no significant difference in LOE incidence between NHWs (3.3 per 1000 person-years) and Hispanics (2.6 per 1000 person-years, p = .875). However, following incident stroke, the risk of LOE differed across racial/ethnic groups. Incident stroke was associated with 2.55 times the risk of LOE among NHWs (95% confidence interval [CI] = .88-7.35), 8.53 times the risk of LOE among Hispanics (95% CI = 5.36-13.57, p = .04 for stronger association than that in NHWs), and 6.46 times the risk of LOE among NHBs (95% CI = 3.79-11.01, p = .12 for stronger association than that in NHWs).
We found a stronger association of incident stroke with LOE risk in Hispanics and NHBs than in NHWs, offering some insight into the racial/ethnic disparities of LOE incidence.
在美国，不同种族/族裔群体中迟发性癫痫（LOE）的发病率鲜为人知，尤其是西班牙裔人群。中风是LOE的一个强有力的预测因素，在非西班牙裔黑人（NHB）和西班牙裔中比在非西班牙裔白人（NHW）中更常见。我们评估了不同种族/族裔群体中LOE的发病率，并研究了中风与LOE风险之间的关联是否因种族/族裔而异。
北曼哈顿研究是一项基于人群的对1993年至2001年期间纳入的老年人的纵向研究。对基线时无中风或癫痫病史的参与者（n = 3419）进行前瞻性随访，以观察LOE的发病率。我们估计了每个种族/族裔群体中每1000人年的LOE发病率。我们使用Cox比例风险回归来评估种族/族裔与LOE的关联，以及种族/族裔与新发中风在LOE方面的相乘交互作用，并对人口统计学和合并诊断进行了调整。
在51176人年的随访期间，183人发生了LOE。NHB中LOE的发病率（每1000人年6.2例）显著高于NHW（每1000人年3.3例，p = 0.004）。NHW（每1000人年3.3例）和西班牙裔（每1000人年2.6例，p = 0.875）之间的LOE发病率没有显著差异。然而，在发生中风后，不同种族/族裔群体中LOE的风险有所不同。在NHW中，新发中风与LOE风险增加2.55倍相关（95%置信区间[CI] = 0.88 - 7.35），在西班牙裔中与LOE风险增加8.53倍相关（95% CI = 5.36 - 13.57，与NHW相比关联更强，p = 0.04），在NHB中与LOE风险增加6.46倍相关（95% CI = 3.79 - 11.01，与NHW相比关联更强，p = 0.12）。
我们发现，与NHW相比，西班牙裔和NHB中新发中风与LOE风险的关联更强，这为LOE发病率的种族/族裔差异提供了一些见解。
