While ischemic heart disease and epilepsy are declining as causes of death in people with epilepsy, the mortality rates in the United States related to epilepsy have risen significantly from 1999 to 2017, according to a study results published in the BMJ Open. Increases in all-neurologic mortality, epilepsy prevalence, vascular dementia, and Alzheimer disease (AD) represent the likely contributors to this rise in epilepsy-related mortality, the study adds.
In this population-based multiple cause-of-death study, investigators retrospectively reviewed the CDC wide-ranging online database (CDC Wonder) to examine cause-of-death data in the United States from 1999 to 2017. The primary outcomes included the change in the age-adjusted epilepsy mortality rates over time compared with the mortality rates for all-causes, all-neurologic disorders, stroke, and degenerative dementia. Changes in the leading causes of death in epilepsy comprised the secondary outcomes.
According to data from the CDC Wonder, epilepsy age-adjusted mortality rates increased by 98.8% between 1999 and 2017 in the United States. Specifically, these mortality rates increased from 5.83 per million to 11.59 per million (95% CI, 88.2%-110.0%; P <.001), respectively. In contrast, the all-cause mortality rate decreased by 16.4%, from 8756.34 per million in 1999 to 7319.17 per million in 2017 (95% CI, 16.3%-16.6%; P <.001). All-neurologic mortality increased by 80.8% during this same period, rising from 309.21 per million in 1999 to 558.97 per million in 2017 (95% CI, 79.4%–82.1%; P <.001).
From 1999 to 2017, the proportion of patients with epilepsy who died due to malignant neoplasms increased by 52.3% (P <.001). Likewise, the proportions of patients with epilepsy who died due to vascular dementia and AD increased by 210.1% (P <.001) and 216.8% (P <.001), respectively. Within this same time period, the proportion of patients who died due to epilepsy decreased by 27.1%. Additionally, ischemic heart disease as a cause of mortality decreased by 42.6% (P <.001).
Limitations of this study included its retrospective nature and the reliance on death certificates. Death certificates may have underreported epilepsy-related mortality, potentially skewing results.
The researchers concluded that “the increased burden and mortality of all-neurological disorders are likely major contributors to the increase in epilepsy mortality rates reported here.”
DeGiorgio CM, Curtis A, Carapetian A, Hovsepian D, Krishnadasan A, Markovic D. Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study. BMJ Open. Published August 24, 2020. doi:10.1136/bmjopen-2019-035767