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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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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 (&lt;18 years old), older people (&gt;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.</abstract><type>Journal Article</type><journal>Epilepsia</journal><volume>65</volume><journalNumber>5</journalNumber><paginationStart>1394</paginationStart><paginationEnd>1405</paginationEnd><publisher>Wiley</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0013-9580</issnPrint><issnElectronic>1528-1167</issnElectronic><keywords>Deaths, health care utilization, real world evidence, routinely collected data, status epilepticus</keywords><publishedDay>10</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-05-10</publishedDate><doi>10.1111/epi.17920</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><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</funders><projectreference/><lastEdited>2024-10-08T11:30:02.5443192</lastEdited><Created>2024-03-10T19:17:57.3812278</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Huw</firstname><surname>Strafford</surname><order>1</order></author><author><firstname>Joseph</firstname><surname>Hollinghurst</surname><order>2</order></author><author><firstname>Arron</firstname><surname>Lacey</surname><orcid>0000-0001-7983-8073</orcid><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Alan</firstname><surname>Watkins</surname><orcid>0000-0003-3804-1943</orcid><order>5</order></author><author><firstname>Jan</firstname><surname>Paterson</surname><order>6</order></author><author><firstname>Daniel</firstname><surname>Jennings</surname><order>7</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>8</order></author><author><firstname>Robert</firstname><surname>Powell</surname><order>9</order></author><author><firstname>Michael P.</firstname><surname>Kerr</surname><order>10</order></author><author><firstname>Richard F.</firstname><surname>Chin</surname><orcid>0000-0002-7256-3027</orcid><order>11</order></author><author><firstname>Owen</firstname><surname>Pickrell</surname><orcid>0000-0003-4396-5657</orcid><order>12</order></author></authors><documents><document><filename>65805__29738__c5bc9d9f20804d91b6f6af4bd7b38aaa.pdf</filename><originalFilename>65805_VoR.pdf</originalFilename><uploaded>2024-03-18T15:56:49.5735429</uploaded><type>Output</type><contentLength>2318450</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© 2024 The Authors. 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spelling v2 65805 2024-03-10 Health care utilization and mortality for people with epilepsy during COVID‐19: A population study a6389fc6d4d18e7b67033ee04b381e43 Huw Strafford Huw Strafford true false d7c51b69270b644a11b904629fe56ab0 Joseph Hollinghurst Joseph Hollinghurst true false b69d245574e754d2637cc9e76379fe11 0000-0001-7983-8073 Arron Lacey Arron Lacey true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 7c8ac48bb6ae4281930e4138f94a51b6 Robert Powell Robert Powell true false 1c3044b5ff7a6552ff5e8c9e3901c807 0000-0003-4396-5657 Owen Pickrell Owen Pickrell true false 2024-03-10 MEDS 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. Journal Article Epilepsia 65 5 1394 1405 Wiley 0013-9580 1528-1167 Deaths, health care utilization, real world evidence, routinely collected data, status epilepticus 10 5 2024 2024-05-10 10.1111/epi.17920 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) 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 2024-10-08T11:30:02.5443192 2024-03-10T19:17:57.3812278 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Huw Strafford 1 Joseph Hollinghurst 2 Arron Lacey 0000-0001-7983-8073 3 Ashley Akbari 0000-0003-0814-0801 4 Alan Watkins 0000-0003-3804-1943 5 Jan Paterson 6 Daniel Jennings 7 Ronan Lyons 0000-0001-5225-000X 8 Robert Powell 9 Michael P. Kerr 10 Richard F. Chin 0000-0002-7256-3027 11 Owen Pickrell 0000-0003-4396-5657 12 65805__29738__c5bc9d9f20804d91b6f6af4bd7b38aaa.pdf 65805_VoR.pdf 2024-03-18T15:56:49.5735429 Output 2318450 application/pdf Version of Record true © 2024 The Authors. This is an open access article under the terms of the Creative Commons Attribution License. true eng http://creativecommons.org/licenses/by/4.0/
title Health care utilization and mortality for people with epilepsy during COVID‐19: A population study
spellingShingle Health care utilization and mortality for people with epilepsy during COVID‐19: A population study
Huw Strafford
Joseph Hollinghurst
Arron Lacey
Ashley Akbari
Alan Watkins
Ronan Lyons
Robert Powell
Owen Pickrell
title_short Health care utilization and mortality for people with epilepsy during COVID‐19: A population study
title_full Health care utilization and mortality for people with epilepsy during COVID‐19: A population study
title_fullStr Health care utilization and mortality for people with epilepsy during COVID‐19: A population study
title_full_unstemmed Health care utilization and mortality for people with epilepsy during COVID‐19: A population study
title_sort Health care utilization and mortality for people with epilepsy during COVID‐19: A population study
author_id_str_mv a6389fc6d4d18e7b67033ee04b381e43
d7c51b69270b644a11b904629fe56ab0
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1c3044b5ff7a6552ff5e8c9e3901c807
author_id_fullname_str_mv a6389fc6d4d18e7b67033ee04b381e43_***_Huw Strafford
d7c51b69270b644a11b904629fe56ab0_***_Joseph Hollinghurst
b69d245574e754d2637cc9e76379fe11_***_Arron Lacey
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
7c8ac48bb6ae4281930e4138f94a51b6_***_Robert Powell
1c3044b5ff7a6552ff5e8c9e3901c807_***_Owen Pickrell
author Huw Strafford
Joseph Hollinghurst
Arron Lacey
Ashley Akbari
Alan Watkins
Ronan Lyons
Robert Powell
Owen Pickrell
author2 Huw Strafford
Joseph Hollinghurst
Arron Lacey
Ashley Akbari
Alan Watkins
Jan Paterson
Daniel Jennings
Ronan Lyons
Robert Powell
Michael P. Kerr
Richard F. Chin
Owen Pickrell
format Journal article
container_title Epilepsia
container_volume 65
container_issue 5
container_start_page 1394
publishDate 2024
institution Swansea University
issn 0013-9580
1528-1167
doi_str_mv 10.1111/epi.17920
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
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description 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.
published_date 2024-05-10T11:30:01Z
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