2006-2023年瑞典三个发病队列癫痫死亡率趋势：一项匹配的基于登记的研究

IF 13 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-07-23 DOI:10.1016/j.lanepe.2025.101388

Johan Zelano , André Idegård , David Larsson

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引用次数: 0

摘要

背景：全球疾病负担研究显示，单是重发性癫痫就造成了很大的健康负担。在人口老龄化的国家，继发性癫痫现在甚至更为常见。改变临床实践和减少使用旧的酶诱导药物可能是有益的，但需要了解所有癫痫的预后趋势。我们的目标是确定和研究2006-2023年瑞典癫痫患者死亡率的趋势。方法通过交叉参考国家患者、药物和死亡原因登记，我们进行了一项匹配的队列研究。我们纳入了2006年以后诊断为癫痫和抗癫痫药物（ASM）的所有患者（n = 61375）和三个年龄/性别匹配的比较者/病例。评估了三个发病率队列的死亡率；2006-2010年、2011-2015年和2016-2020年，共分为四个亚组：年龄50岁、血管疾病、全身性癫痫和年龄20岁。采用Cox回归评估死亡风险。在2006-2010年，卡巴马西平和丙戊酸是常见的首个asm，但在2016-2020年被左乙拉西坦取代。丙戊酸在广泛性癫痫中越来越少见。2006-2010年校正后死亡风险比为1.99(95%可信区间[CI]:1.90 - 2.08)， 2016-2020年校正后死亡风险比为1.90（95%可信区间[CI]: 1.82-1.99）。2016-2020年期间，心血管疾病患者与比较组的调整后死亡率为1.59 （95% CI: 1.50-1.68）。敏感性分析显示，我们的队列中心血管死亡的额外风险已经降低。年轻癫痫患者的死亡率增加了30-50倍。痴呆和血管疾病是癫痫患者死亡的重要危险因素。解释：相对于年龄和性别匹配的比较者，癫痫的死亡率基本保持不变。非诱导性asm的使用增加可能会略微降低血管风险。应针对特定的患者群体进行努力，特别是针对年轻人的癫痫管理以及老年癫痫患者的血管和神经退行性合并症。资助瑞典研究委员会，瑞典国家通过ALF协议，Knut和Ragnvi雅各布森基金会。

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Trends in epilepsy mortality of three incidence cohorts across 2006–2023 in Sweden: a matched register-based study

Background

Idiopathic epilepsy alone accounts for a large health burden as shown in the Global Burden of Diseases Study. In countries with ageing populations, secondary epilepsies are now even more common. Altered clinical practice and reduced use of older enzyme-inducing drugs may be beneficial, but understanding of trends in the prognosis of all epilepsy is needed. Our objective was to determine and study trends in mortality in persons with epilepsy in Sweden through 2006–2023.

Methods

We performed a matched cohort study by cross-referencing National Patient, Drug, and Cause of Death Registers. We included all persons with a diagnosis of epilepsy and antiseizure medication (ASM) after 2006 (n = 61,375) and three age-/sex-matched comparators/case. Mortality was assessed for three incidence cohorts; 2006–2010, 2011–2015, and 2016–2020, totally and in four subgroups: age >50, vascular disease, generalized epilepsy, and age <20. Risk of death was assessed by Cox regression.

Findings

Carbamazepine and valproic acid were common first ASMs in 2006–2010, but replaced by levetiracetam by 2016–2020. Valproate became less common in generalized epilepsy. The adjusted hazard ratio [HR] for death was 1.99 (95% confidence interval [CI]:1.90–2.08) in 2006–2010 and 1.90 (95% CI: 1.82–1.99) in 2016–2020. The adjusted HR for death was 1.59 (95% CI: 1.50–1.68) for persons with cardiovascular disease versus comparators during 2016–2020. A sensitivity analysis showed that the excces risk of cardiovascular death had decreased between our cohorts. Young persons with epilepsy had a 30–50 fold increased HR of death. Dementia and vascular disease were important risk factors for death in persons with epilepsy.

Interpretation

Mortality in epilepsy has remained largely unchanged relative to age- and sex matched comparators. The increased use of non-inducing ASMs may have reduced vascular risk slightly. Efforts should be targeted to specific patient groups, particularly regarding epilepsy management in the young and vascular and neurodegenerative comorbidities in older persons with epilepsy.

Funding

Swedish Research Council, Swedish State through the ALF agreement, Knut and Ragnvi Jacobsson foundation.

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.