Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R).
Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R).
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DOI：
10.1038/mp.2011.56
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发表时间：
2012-07
影响因子：
11
通讯作者：
Stang PE
中科院分区：
文献类型：
--
作者：
Kessler RC;Lane MC;Shahly V;Stang PE
虽然癫痫与实质性的角色障碍相关，但它也与其他身体和精神障碍高度共病，使得与癫痫相关的障碍实际上是由于共病的程度不清楚。这个问题在全国科摩罗重复调查（NCS-R）中进行了探讨，NCS-R是一项对5，692名美国成年人进行的全国代表性家庭调查。通过自我报告确定医学上认可的癫痫，通过慢性疾病检查表确定共病身体障碍，通过复合国际诊断访谈（CIDI）确定共病DSM-IV精神障碍。终生癫痫患病率估计为1.8%。癫痫与许多神经系统和一般医学疾病共病，并伴有零星的精神共病（恐慌、PTSD、行为障碍和物质使用障碍）。虽然共病疾病解释了癫痫与损害的显著总体相关性的一部分，但癫痫仍然与工作障碍、认知障碍和控制共病后的角色障碍天数显著相关。在控制合并症后，癫痫与角色损害天数的净相关性相当于美国癫痫成年人每年8940万个多余的角色损害天数，认为角色损害是癫痫本身社会成本的主要组成部分，而不仅仅是由于癫痫合并症引起的疾病。这一估计的负担可能是保守的，因为癫痫的某些影响可能是由继发性共病疾病介导的。
Although epilepsy is associated with substantial role impairment, it is also highly comorbid with other physical and mental disorders, making unclear the extent to which impairments associated with epilepsy are actually due to comorbidities. This issue was explored in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 5,692 US adults. Medically-recognized epilepsy was ascertained with self-report, comorbid physical disorders with a chronic conditions checklist, and comorbid DSM-IV mental disorders with the Composite International Diagnostic Interview (CIDI). Lifetime epilepsy prevalence was estimated at 1.8%. Epilepsy was comorbid with numerous neurological and general medical conditions and with a sporadic cluster of mental comorbidities (panic, PTSD, conduct disorder, and substance use disorders). Although comorbid disorders explain part of the significant gross associations of epilepsy with impairment, epilepsy remains significantly associated with work disability, cognitive impairment, and days of role impairment after controlling comorbidities. The net association of epilepsy with days of role impairment after controlling for comorbidities is equivalent to an annualized 89.4 million excess role impairment days among US adults with epilepsy, arguing that role impairment is a major component of the societal costs of epilepsy per se rather than merely due to disorders comorbid with epilepsy. This estimated burden is likely conservative as some parts of the effects of epilepsy are presumably mediated by secondary comorbid disorders.
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