Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study.
Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study.
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DOI：
10.1016/s0140-6736(13)60899-5
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发表时间：
2013-11-16
期刊：
影响因子：
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通讯作者：
Lichtenstein P
中科院分区：
文献类型：
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作者：
Fazel S;Wolf A;Långström N;Newton CR;Lichtenstein P
癫痫与高过早死亡率有关，但精神疾病的共病对癫痫的影响尚不确定。我们评估了有或无精神合并症的癫痫患者因外部原因（如自杀、事故和袭击）而过早死亡的患病率和风险。我们研究了1954年至2009年间出生在瑞典的所有住院和门诊诊断为癫痫的个体（n= 69995），以了解过早死亡的风险和原因。将患者与年龄匹配和性别匹配的一般人群对照（n=660 869）和未受影响的兄弟姐妹（n=81 396）进行比较。进行敏感性分析以调查这些几率是否因性别、年龄、癫痫发作类型、共病精神诊断以及癫痫诊断后的不同时间段而不同。随访期间有6155例（8.8%）癫痫患者死亡，中位年龄为34.5岁（IQR为21.0 ~ 44.0），过早死亡的几率显著升高（校正比值比[aOR]为11.1 [95% CI 10.6 ~ 11.6]，与未患病的兄弟姐妹相比为11.4[10.4 ~ 12.5]）。其中，15.8% （n=972）为外因死亡，非机动车事故（aOR为5.5,95% CI为4.7 - 6.5）和自杀（3.7,3.3 - 4 - 2）的几率较高。在外因死亡的患者中，75.2%伴有精神疾病共病，与无癫痫和无精神疾病共病的患者相比，伴有抑郁症（13.0,10.3 - 16.6）和药物滥用（22.4,18.3 - 27.3）的患者有很强的相关性。减少外因导致的过早死亡应是癫痫管理的一个重点。精神合并症在癫痫患者过早死亡中起重要作用。需要审查卫生服务和公共卫生措施预防此类死亡的能力。威康信托，瑞典监狱和缓刑服务，以及瑞典研究委员会。
Epilepsy is associated with high rates of premature mortality, but the contribution of psychiatric comorbidity is uncertain. We assessed the prevalence and risks of premature mortality from external causes such as suicide, accidents, and assaults in people with epilepsy with and without psychiatric comorbidity. We studied all individuals born in Sweden between 1954 and 2009 with inpatient and outpatient diagnoses of epilepsy (n=69 995) for risks and causes of premature mortality. Patients were compared with age-matched and sex-matched general population controls (n=660 869) and unaffected siblings (n=81 396). Sensitivity analyses were done to investigate whether these odds differed by sex, age, seizure types, comorbid psychiatric diagnosis, and different time periods after epilepsy diagnosis. 6155 (8.8%) people with epilepsy died during follow-up, at a median age of 34·5 (IQR 21·0–44·0) years with substantially elevated odds of premature mortality (adjusted odds ratio [aOR] of 11·1 [95% CI 10·6–11·6] compared with general population controls, and 11·4 [10·4–12·5] compared with unaffected siblings). Of those deaths, 15·8% (n=972) were from external causes, with high odds for non-vehicle accidents (aOR 5·5, 95 % CI 4·7–6·5) and suicide (3·7, 3·3–4·2). Of those who died from external causes, 75·2% had comorbid psychiatric disorders, with strong associations in individuals with co-occurring depression (13·0, 10·3–16·6) and substance misuse (22·4, 18·3–27·3), compared with patients with no epilepsy and no psychiatric comorbidity. Reducing premature mortality from external causes of death should be a priority in epilepsy management. Psychiatric comorbidity plays an important part in the premature mortality seen in epilepsy. The ability of health services and public health measures to prevent such deaths requires review. Wellcome Trust, the Swedish Prison and Probation Service, and the Swedish Research Council.