Increased Physical, Mental Comorbidity in Veterans With Epilepsy

US veterans with epilepsy who were deployed to Iraq and Afghanistan are more likely to have mental and physical comorbidities compared with those without epilepsy, and were 2.6 times more likely to die during 2011-2015, even after controlling for demographic characteristics and other conditions associated with death. The findings were published in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR).¹

Although it is known that seizure disorders are associated with traumatic brain injury, there was previously a lack of information about epilepsy, seizures, and comorbidity in veterans with epilepsy who were deployed in Iraq and Afghanistan.

Using data from the US Department of Veterans Affairs, Veterans Health Administration (VA), Mary Jo Pugh, PhD, from the US Department of Veterans Affairs Epilepsy Centers of Excellence, South Texas Veterans Health Care System, and the University of Texas Health Science Center at San Antonio, and colleagues developed a cohort study to identify epilepsy, demographic characteristics, and baseline comorbidity in veterans who received VA care in 2010 and 2011. 

Out of 320,583 veterans who received VA care in 2010 and 2011, 2187 (0.7%) met the criteria for epilepsy. Veterans with epilepsy were more likely to be white and older than 40 years, and were more likely than those without epilepsy to have the following 16 comorbid conditions: post-traumatic stress disorder (PTSD), depression, traumatic brain injury, substance use disorder, hypertension, obesity, bipolar disorder, suicidality, cerebrovascular disease, cardiac disease, diabetes, cancer (non-skin cancer), overdose, liver disease, schizophrenia, and kidney disease.

Approximately 5 times more veterans with epilepsy (4.6% [n= 101]) died by the end of follow-up compared with those without epilepsy (1.0% [n= 3136]) (unadjusted hazard ratio [HR], 4.8; CI 3.9–5.9). After controlling for demographic characteristics and comorbid conditions, mortality was still more likely among veterans with epilepsy than those without epilepsy (adjusted HR, 2.6; CI 2.1–3.2).

“A significantly higher prevalence of comorbidities in this population suggests that closer integration of primary care, epilepsy specialty care, and mental health care might be needed to reduce excess mortality,” the authors wrote.

The researchers concluded that to help veterans with epilepsy, public health agencies, including the VA, can implement evidence-based chronic disease self-management programs targeting physical and psychiatric comorbidities that study long-term outcomes including cause of death, and that provide veterans with links to VA clinical care, community health care, and social service providers.²

References

1. Pugh MJ, Van Cott AC, Amuan M, et al. Epilepsy among Iraq and Afghanistan war veterans—United States, 2002-2015. CDC MMWR. 2016; 65(44);1224–1227. doi:10.15585/mmwr.mm6544a5.
2. Brady TJ, Anderson LA, Kobau R. Chronic disease self-management support: public health perspectives. Front Public Health. 2015;2:234.