2024-03-06 スウォンジー大学
<関連情報>
- https://www.swansea.ac.uk/press-office/news-events/news/2024/03/impact-of-covid-on-people-with-epilepsy-higher-rate-of-deaths-and-hospitalisations-new-research-shows.php
- https://onlinelibrary.wiley.com/doi/10.1111/epi.17910
- https://onlinelibrary.wiley.com/doi/10.1111/epi.17920
てんかんとCOVID-19関連入院・死亡リスク: 集団研究 Epilepsy and the risk of COVID-19-related hospitalization and death: A population study
Huw Strafford, Joe Hollinghurst, Arron S. Lacey, Ashley Akbari, Alan Watkins, Jan Paterson, Daniel Jennings, Ronan A. Lyons, H. Robert Powell, Michael P. Kerr, Richard F. Chin, William O. Pickrell
Epilepsia Published: 05 March 2024
DOI:https://doi.org/10.1111/epi.17910
Abstract
Objective
People with epilepsy (PWE) may be at an increased risk of severe COVID-19. It is important to characterize this risk to inform PWE and for future health and care planning. We assessed whether PWE were at higher risk of being hospitalized with, or dying from, COVID-19.
Methods
We performed a retrospective cohort study using linked, population-scale, anonymized electronic health records from the SAIL (Secure Anonymised Information Linkage) databank. This includes hospital admission and demographic data for the complete Welsh population (3.1 million) and primary care records for 86% of the population. We identified 27 279 PWE living in Wales during the study period (March 1, 2020 to June 30, 2021). Controls were identified using exact 5:1 matching (sex, age, and socioeconomic status). We defined COVID-19 deaths as having International Classification of Diseases, 10th Revision (ICD-10) codes for COVID-19 on death certificates or occurring within 28 days of a positive SARS-CoV-2 polymerase chain reaction (PCR) test. COVID-19 hospitalizations were defined as having a COVID-19 ICD-10 code for the reason for admission or occurring within 28 days of a positive SARS-CoV-2 PCR test. We recorded COVID-19 vaccinations and comorbidities known to increase the risk of COVID-19 hospitalization and death. We used Cox proportional hazard models to calculate hazard ratios.
Results
There were 158 (.58%) COVID-19 deaths and 933 (3.4%) COVID-19 hospitalizations in PWE, and 370 (.27%) deaths and 1871 (1.4%) hospitalizations in controls. Hazard ratios for COVID-19 death and hospitalization in PWE compared to controls were 2.15 (95% confidence interval [CI] = 1.78–2.59) and 2.15 (95% CI = 1.94–2.37), respectively. Adjusted hazard ratios (adjusted for comorbidities) for death and hospitalization were 1.32 (95% CI = 1.08–1.62) and 1.60 (95% CI = 1.44–1.78).
Significance
PWE are at increased risk of being hospitalized with, and dying from, COVID-19 when compared to age-, sex-, and deprivation-matched controls, even when adjusting for comorbidities. This may have implications for prioritizing future COVID-19 treatments and vaccinations for PWE.
Key points
- We identified 27 279 people with epilepsy (136 395 controls) during the first 15 months of the COVID-19 pandemic in Wales.
- People with epilepsy have increased risk of being hospitalized with, and dying from, COVID-19 when compared to matched controls.
- This overall increased risk remained after adjusting for comorbidities associated with higher COVID-19 risk.
COVID-19期間中のてんかん患者の医療利用率と死亡率: 集団調査 Health care utilization and mortality for people with epilepsy during COVID-19: A population study
Huw Strafford, Joe Hollinghurst, Arron S. Lacey, Ashley Akbari, Alan Watkins, Jan Paterson, Daniel Jennings, Ronan A. Lyons, H. Robert Powell, Michael P. Kerr, Richard F. Chin, William O. Pickrell
Epilepsia Published: 05 March 2024
DOI:https://doi.org/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 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.
