Disparities in epilepsy-associated mortality trends in the United States of America over two decades

Abstract

Introduction

Epilepsy affects millions of people in the US annually, leading to disability and death. This study aims to comprehensively delve into the epidemiological framework of epilepsy-related mortality by stratification of data through gender, ethnicity, and geographical regions over two decades, as these have not been done previously to this extent, with a view to addressing the target population precisely.

Methods

This retrospective study analyzed epilepsy-related mortality data in the United States from the CDC (Centers for Disease Control and Prevention) database of all age groups using ICD-10 codes of G40.0 to G40.9 from 1999 to 2020. Age-adjusted Mortality rates (AAMRs) per 100,000 persons were calculated and categorized by year, sex, race/ethnicity, place of death, and geographic location. The Joinpoint regression analyzed these AAMRs to produce annual percent changes (APCs) to assess mortality trend changes.

Results

A total of 57,304 Epilepsy related deaths occurred between 1999 and 2020 in the United States. The overall AAMR for epilepsy in 1999 was 0.6 (95 % CI, 0.5 to 0.6) and increased to 1.64 (95 % CI, 1.59 to 1.68) in 2020. Men exhibited a higher AAMR than females throughout the study period from 1999 (0.7 vs. 0.47) to 202O (1.84 vs. 1.46); a significant rise was seen in APC for both genders in the second decade, i.e., 2010 to 2020. The highest mortality was noted in Non-Hispanic (NH) black or African Americans (AAMR:1.38), followed by NH American Indian or Alaskan Natives (AAMR:1.07), NH White (AAMR:0.76), Hispanics or Latinos (AAMR:0.76), and NH Asian or Pacific Islanders (AAMR:0.32). Regional analysis showed disparities in AAMR, the West being most prominent with an AAMR reported to be 1.04, followed by the Midwest regions (AAMR: 0.88), the South regions (AAMR: 0.77), and the Northeast regions (AAMR: 0.53). The states with AAMRs in the top 90th percentile included Iowa, Mississippi, Colorado, South Dakota, and Michigan, with non-metropolitan regions having higher AAMRs (0.92) than metropolitan counterparts (0.76).

Conclusion

The findings of our study emphasize the critical importance of addressing the rise in mortality, especially in the second decade, by devising strategies and policies targeting at-risk populations and improving the management framework for such patients, with more widespread public awareness regarding the disease and its risk factors.