Comorbidities (having two or more disease at the same time) are higher in people with epilepsy than in the general population. My objective will be to assess the incidence and prevalence of comorbidities before and after diagnosis of epilepsy compared to persons without epilepsy. The impact of epilepsy is even greater on patients, their families, and society when psychiatric and somatic comorbidities co-exist. Few population-based studies have shown that epilepsy leads to some psychiatric comorbidities (depression, suicide, psychosis) and vice-versa. There are to our knowledge no population-based studies looking at the incidence of medical comorbidities as well as other psychiatric disorders in those with epilepsy before and after diagnosis. Attempting to define the timeline of comorbidities may provide important clues to the fundamental mechanisms and management of epilepsy and associated conditions. We propose comprehensively examining the comorbidities associated with epilepsy, as well as examining the associated risk of death and health resource utilisation in order to improve care for this vulnerable population.
The objectives of this study are to determine: 1)whether comorbidities (somatic/psychiatric) differ in persons with epilepsy compared to age and sex matched peers without epilepsy 2)if persons with epilepsy are at increased risk of premature death 3)patterns of health care use in this population.
Two populations will be identified from linked United Kingdom administrative/electronic medical record databases (Clinical Practice Research Datalink (CPRD), Hospital Episodes Statistics (HES), Office for National Statistics (ONS)). Patients with newly diagnosed epilepsy as cases and persons without epilepsy as controls will be ascertained using validated Read code (or equivalent International Classification of Disease, Tenth Revision (ICD-10)) epilepsy case definitions. Ten persons without epilepsy will be matched to one person with epilepsy by age and sex. Comorbidities will be defined using Read codes (or equivalent ICD-10 coding algorithms) that have been developed as part of the CALIBER programme. Presence of comorbidities pre- and post-epilepsy diagnosis will be determined by matching diagnosis codes with the coding algorithms.
Objective 1 will be addressed as follows: rate ratios will be calculated to determine whether the prevalence and incidence of comorbidities differ between those with and those without epilepsy pre- and post- diagnosis, and in those with epilepsy before and after the diagnosis of epilepsy. The Mantel-Haenszel test will be used to determine statistical significance of the rate ratios. In order to examine factors associated with the development of medical or psychiatric comorbidities in persons with epilepsy unadjusted and adjusted regression analyses will be performed, adjusting for relevant patient-, clinical- and hospital-level factors. Objective 2: hazard of all-cause death as determined from ONS data using multivariable Cox regression models to determine the risk of all-cause death will be evaluated. Objective 3: Parametric, non-parametric descriptive statistics will be used where appropriate for health resource utilization as well as through regression modelling.
Comorbidites
Psychiatric conditions (measured as a binary variable)
-Depression
-Alcohol abuse
-Drug abuse
-Psychoses
-Depression
-Personality disorder
-OCD
-Anxiety
-Eating disorder
-Post-traumatic stress disorder
-Suicide/suicidal ideation
-Homicide
Somatic conditions (Measured as a binary variable)
Charlson comorbidity index
-Acute myocardial infarction
-Congestive heart failure
-Peripheral vascular disease
-Cerebro-vascular disease
-Chronic pulmonary disease
-Dementia
-Chronic pulmonary disease
-Connective tissue disease
-Peptic ulcer disease
-Mild liver disease
-Diabetes, uncomplicated
-Diabetes with complications
-Hemiplegia or paraplegia
-Renal disease
-Any malignancy without metastasis
-Leukemia
-Lymphoma
-Moderate or severe liver disease
-Metastatic solid tumor
-AIDS (excluding asymptomatic infection)
Elixhauser comorbidity index
-Congestive heart failure
-Cardiac arrhythmias
-Valvular disease
-Pulmonary circulation disorders
-Peripheral vascular disorders
-Hypertension
-Crohn’s
-Ulcerative colitis
-Coeliac disease
-Diabetes, uncomplicated
-Diabetes, complicated
-Thyroid disease
-Renal disease
-Liver disease
-Peptic ulcer disease excluding bleeding
-AIDS/HIV
-Lymphoma
-Metastatic cancer
-Solid tumor without metastasis
-Rheumatoid arthritis/collagen vascular diseases
-Coagulopathy
-Obesity
-Deficiency anemia
-Anemia - other
-Other haemolytic anaemias
Neurological disease not included in the comorbidity indices above (Measured as a binary variable)
-Parkinson’s Disease
-Essential tremor
-Multiple sclerosis
-Migraine
-Motor Neuron Disease
-Myasthenia Gravis
-Sleep disorder
-Autism
-Hyperkinetic disorders
-Intellectual disability
Mortality
Health resource utilisation
Churl-Su Kwon - Chief Investigator - University of Oxford
Churl-Su Kwon - Corresponding Applicant - University of Oxford
Charles Newton - Collaborator - University of Oxford
Clare Bankhead - Collaborator - University of Oxford
Cynthia Wright Drakesmith - Collaborator - University of Oxford
Margaret Smith - Collaborator - University of Oxford
Nathalie Jette - Collaborator - Icahn School of Medicine at Mount Sinai
Subhashisa Swain - Collaborator - University of Oxford
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation