确诊晚发性癫痫后,过度使用医疗服务的情况会明显持续减少。

IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY
Epilepsia Pub Date : 2024-09-20 DOI:10.1111/epi.18105
Marta Berglund, Arturo Gonzalez-Izquierdo, Spiros Denaxas, B Cord Lethebe, Tolulope T Sajobi, Jordan D T Engbers, Samuel Wiebe, Colin B Josephson
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引用次数: 0

摘要

目的:晚发性癫痫(LOE)的发病率正在上升,这些患者可能会使用过多的医疗资源。本研究旨在测量晚发性癫痫患者与对照组相比在诊断前后的医疗资源使用情况(HCU):这是一项开放式队列观察研究,研究时间跨度为1998年至2019年,使用的是英国基于人群的链接初级保健(临床实践研究数据链[CPRD])和医院(HES)电子健康记录。参与者包括在 CPRD 登记的事件性 LOE 患者和 1:10 的年龄、性别和全科匹配对照组。暴露为事件性LOE(诊断年龄≥65岁),采用5年冲洗法。主要结果是所有HCU(初级保健[PC]、事故和急诊[A&E]、住院病人和门诊病人护理),采用反比例加权法对PC使用和HCU进行设置。采用间断时间序列分析法对LOE患者和对照组在诊断/配对日期两侧4年内的诊断前/诊断后HCU进行检查。对诊断后HCU的交互作用采用了调整后的混合负二项回归:在2 569 874名年龄≥65岁的患者中,1048人(4%)发生了LOE。在确诊 LOE 之前,每名患者每年的平均加权总 HCU 增加了 32 次(95% 置信区间 [95%CI]:13-50,p = .003),之后每名患者每年平均减少了 60 次(95% CI:-81 至 -40)。在确诊前后的1-2年时间里,就诊率急剧上升和下降。与对照组相比,LOE 在诊断后的 HCU 发生率仍然较高(调整后的发生率比值:1.72;95% CI:1.65-1.70;P 意义重大:在LOE确诊前的4年中,医疗服务的使用呈现出由急性到慢性的上升趋势。与对照组相比,诊断前急性上升的部分逆转以及加速上升的介导因素在多大程度上归因于癫痫、合并和双向疾病状态或两者的结合,值得进一步探讨。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Excess health care use is significantly and persistently reduced following diagnosis of late-onset epilepsy.

Objective: The incidence of late-onset epilepsy (LOE) is rising, and these patients may use an excess of health care resources. This study aimed to measure pre-/post-diagnostic health care use (HCU) for patients with LOE compared to controls.

Methods: This was an observational open cohort study covering years 1998-2019 using UK population-based linked primary care (Clinical Practice Research Datalink [CPRD]) and hospital (HES) electronic health records. The participants included patients with incident LOE enrolled in CPRD and 1:10 age-, sex-, and general practice-matched controls. The exposure was incident LOE (diagnosed at age ≥65) using a 5-year washout. The main outcome was all HCU (primary care [PC], accident and emergency [A&E], admitted patient and outpatient care) using inverse proportional weighting to PC use and HCU by setting. An interrupted time-series analysis was used to examine pre-/post-diagnostic HCU between patients with LOE and controls over 4 years either side of diagnosis/matching date. An adjusted mixed-effects negative binomial regression was used for post-diagnosis HCU interactions.

Results: Of 2 569 874 people ≥65 years of age, 1048 (4%) developed incident LOE. Mean weighted total HCU increased by 32 visits per patient-year (95% confidence interval [95% CI]: 13-50, p = .003) until LOE diagnosis, and then dropped by a mean of 60 visits per patient-year (95% CI: -81 to -40). There was an acute rise and fall over the 1-2 years immediately pre-/post-diagnosis. Incident HCU remained higher for LOE compared to controls post-diagnosis (adjusted incidence rate ratio: 1.72; 95% CI: 1.65-1.70; p < .001), including A&E, outpatient, and admitted care.

Significance: Health care use demonstrates an acute on chronic rise over the 4 years before diagnosis of LOE. To what extent the partial reversal of the acute pre-diagnosis rise, and the mediators of the accelerated increase compared to controls are attributed to epilepsy, comorbid and bidirectional disease states, or a combination of both warrants further exploration.

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来源期刊
Epilepsia
Epilepsia 医学-临床神经学
CiteScore
10.90
自引率
10.70%
发文量
319
审稿时长
2-4 weeks
期刊介绍: Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.
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