Esma Cihan1, Dale C Hesdorffer1, Michael Brandsoy1, Ling Li1, David R Fowler1, Jason K Graham1, Michael Karlovich1, Elizabeth J Donner1, Orrin Devinsky1, Daniel Friedman2. 1. From the Department of Neurology (E.C., M.K., O.D., D.F.), NYU School of Medicine; Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; San Diego County Medical Examiner's Office (M.B.), CA; Maryland Office of the Chief Medical Examiner (L.L., D.R.F.), Baltimore; New York City Office of Chief Medical Examiner (J.K.G.), NY; and Department of Paediatrics (E.J.D.), Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada. 2. From the Department of Neurology (E.C., M.K., O.D., D.F.), NYU School of Medicine; Department of Epidemiology (D.C.H.), Columbia University Medical Center, New York, NY; San Diego County Medical Examiner's Office (M.B.), CA; Maryland Office of the Chief Medical Examiner (L.L., D.R.F.), Baltimore; New York City Office of Chief Medical Examiner (J.K.G.), NY; and Department of Paediatrics (E.J.D.), Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada. Daniel.Friedman@nyulangone.org.
Abstract
OBJECTIVE: To determine the impact of socioeconomic status (SES) on sudden unexpected death in epilepsy (SUDEP) rates. METHODS: We queried all decedents presented for medico-legal investigation at 3 medical examiner (ME) offices across the country (New York City, Maryland, San Diego County) in 2009 to 2010 and 2014 to 2015. We identified all decedents for whom epilepsy/seizure was listed as cause/contributor to death or comorbid condition on the death certificate. We then reviewed all available reports. Decedents determined to have SUDEP were included for analysis. We used median income in the ZIP code of residence as a surrogate for SES. For each region, zip code regions were ranked by median household income and divided into quartiles based on total population for 2 time periods. Region-, age-, and income-adjusted epilepsy prevalence was estimated in each zip code. SUDEP rates in the highest and lowest SES quartiles were evaluated to determine disparity. Examined SUDEP rates in 2 time periods were also compared. RESULTS: There were 159 and 43 SUDEP cases in the lowest and highest SES quartiles. ME-investigated SUDEP rate ratio between the lowest and highest SES quartiles was 2.6 (95% confidence interval [CI] 1.7-4.1, p < 0.0001) in 2009 to 2010 and 3.3 (95% CI 1.9-6.0, p < 0.0001) in 2014 to 2015. There was a significant decline in overall SUDEP rate between the 2 study periods (36% decrease, 95% CI 22%-48%, p < 0.0001). CONCLUSION: ME-investigated SUDEP incidence was significantly higher in people with the lowest SES compared to the highest SES. The difference persisted over a 5-year period despite decreased overall SUDEP rates.
OBJECTIVE: To determine the impact of socioeconomic status (SES) on sudden unexpected death in epilepsy (SUDEP) rates. METHODS: We queried all decedents presented for medico-legal investigation at 3 medical examiner (ME) offices across the country (New York City, Maryland, San Diego County) in 2009 to 2010 and 2014 to 2015. We identified all decedents for whom epilepsy/seizure was listed as cause/contributor to death or comorbid condition on the death certificate. We then reviewed all available reports. Decedents determined to have SUDEP were included for analysis. We used median income in the ZIP code of residence as a surrogate for SES. For each region, zip code regions were ranked by median household income and divided into quartiles based on total population for 2 time periods. Region-, age-, and income-adjusted epilepsy prevalence was estimated in each zip code. SUDEP rates in the highest and lowest SES quartiles were evaluated to determine disparity. Examined SUDEP rates in 2 time periods were also compared. RESULTS: There were 159 and 43 SUDEP cases in the lowest and highest SES quartiles. ME-investigated SUDEP rate ratio between the lowest and highest SES quartiles was 2.6 (95% confidence interval [CI] 1.7-4.1, p < 0.0001) in 2009 to 2010 and 3.3 (95% CI 1.9-6.0, p < 0.0001) in 2014 to 2015. There was a significant decline in overall SUDEP rate between the 2 study periods (36% decrease, 95% CI 22%-48%, p < 0.0001). CONCLUSION: ME-investigated SUDEP incidence was significantly higher in people with the lowest SES compared to the highest SES. The difference persisted over a 5-year period despite decreased overall SUDEP rates.
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