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Health care utilization and mortality for people with epilepsy during COVID‐19: A population study

Huw Strafford, Joseph Hollinghurst, Arron Lacey Orcid Logo, Ashley Akbari Orcid Logo, Alan Watkins Orcid Logo, Jan Paterson, Daniel Jennings, Ronan Lyons Orcid Logo, Robert Powell, Michael P. Kerr, Richard F. Chin Orcid Logo, Owen Pickrell Orcid Logo

Epilepsia, Volume: 65, Issue: 5, Pages: 1394 - 1405

Swansea University Authors: Huw Strafford, Joseph Hollinghurst, Arron Lacey Orcid Logo, Ashley Akbari Orcid Logo, Alan Watkins Orcid Logo, Ronan Lyons Orcid Logo, Robert Powell, Owen Pickrell Orcid Logo

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DOI (Published version): 10.1111/epi.17920

Abstract

Objective: This study was undertaken to characterize changes in health care utilization and mortality for people with epilepsy (PWE) during the COVID-19 pandemic. Methods: We performed a retrospective study using linked, individual-level, population-scale anonymized health data from the Secure Anony...

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Published in: Epilepsia
ISSN: 0013-9580 1528-1167
Published: Wiley 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa65805
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Abstract: Objective: This study was undertaken to characterize changes in health care utilization and mortality for people with epilepsy (PWE) during the COVID-19 pandemic. Methods: We performed a retrospective study using linked, individual-level, population-scale anonymized health data from the Secure Anonymised Information Linkage databank. We identified PWE living in Wales during the study “pandemic period” (January 1, 2020–June 30, 2021) and during a “prepandemic” period (January 1, 2016–December 31, 2019). We compared prepandemic health care utilization, status epilepticus, and mortality rates with corresponding pandemic rates for PWE and people without epilepsy (PWOE). We performed subgroup analyses on children (<18 years old), older people (>65 years old), those with intellectual disability, and those living in the most deprived areas. We used Poisson models to calculate adjusted rate ratios (RRs). Results: We identified 27 279 PWE who had significantly higher rates of hospital (50.3 visits/1000 patient months), emergency department (55.7), and outpatient attendance (172.4) when compared to PWOE (corresponding figures: 25.7, 25.2, and 87.0) in the prepandemic period. Hospital and epilepsy-related hospital admissions, and emergency department and outpatient attendances all reduced significantly for PWE (and all subgroups) during the pandemic period. RRs [95% confidence intervals (CIs)] for pandemic versus prepandemic periods were .70 [.69–.72], .77 [.73–.81], .78 [.77–.79], and .80 [.79–.81]. The corresponding rates also reduced for PWOE. New epilepsy diagnosis rates decreased during the pandemic compared with the prepandemic period (2.3/100 000/month cf. 3.1/100 000/month, RR = .73, 95% CI = .68–.78). Both all-cause deaths and deaths with epilepsy recorded on the death certificate increased for PWE during the pandemic (RR = 1.07, 95% CI = .997–1.145 and RR = 2.44, 95% CI = 2.12–2.81). When removing COVID deaths, RRs were .88 (95% CI = .81–.95) and 1.29 (95% CI = 1.08–1.53). Status epilepticus rates did not change significantly during the pandemic (RR = .95, 95% CI = .78–1.15). Significance: All-cause non-COVID deaths did not increase but non-COVID deaths associated with epilepsy did increase for PWE during the COVID-19 pandemic. The longer term effects of the decrease in new epilepsy diagnoses and health care utilization and increase in deaths associated with epilepsy need further research. Key Points: People with epilepsy have increased rates of hospital, emergency department, and outpatient attendance when compared to people without epilepsy.These rates (and rates of new epilepsy diagnoses) reduced significantly during our pandemic study period (January 1, 2020–June 30, 2021).Rates of status epilepticus did not change during the pandemic period.All-cause non-COVID deaths did not increase for people with epilepsy.There was a small increase in non-COVID deaths with epilepsy listed as a cause for people with epilepsy.
Keywords: Deaths, health care utilization, real world evidence, routinely collected data, status epilepticus
College: Faculty of Medicine, Health and Life Sciences
Funders: Health and Care Research Wales, Grant/Award Number: HDR-9006; UK Medical Research Council; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Department of Health and Social Care (England); Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Health and Social Care Research and Development Division (Welsh Government); Public Health Agency (Northern Ireland); British Heart Foundation; Wellcome Trust; Medical Research Council, Grant/Award Number: MR/V028367/1; ADR UK, Grant/Award Number: ES/S007393/1; Wales COVID-19 Evidence Centre
Issue: 5
Start Page: 1394
End Page: 1405

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