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More surveillance, research needed on premature death in children with epilepsy
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More research and expanded surveillance is needed to better understand excess mortality among children with epilepsy, according to study findings published in MMWR.
Researchers analyzed statewide data from 2000 to 2011 on hospital discharges, ED visits, hospital-based outpatient clinics and deaths with multiple causes in South Carolina to assess the burden of premature mortality among children with epilepsy.
From 2000 to 2011, researchers identified 13,099 children aged 0 to 18 years with epilepsy. The overall mortality rate was 8.8 deaths per 1,000 person-years. Children with epilepsy had an annual risk for death of 0.84%, compared with 0.22% among children without epilepsy.
Median age at diagnosis was 8 years among the study population.
Age at diagnosis, sex, race/ethnicity and place of residence did not differ between children with epilepsy who died and those who survived. However, children with epilepsy who died were more likely to have Medicare and less likely to be uninsured compared with those who survived.
Non-Hispanic blacks accounted for 29% of the state population; 38% of children with epilepsy and 41.4% of those who died.
The mortality rate for non-Hispanic white children aged 0 to 5 years was significantly higher than that of children aged 6 to 12 years: 9.8 vs. 5.7 per 1,000 person-years. Non-Hispanic black children aged 13 to 18 years had an even higher mortality rate of 12.4 per 1,000 person-years.
From 2000 to 2008, annual age-adjusted mortality rates increased from 2.1 to 5.6 per 100,000 (P=.015). However, annual rates decreased to 3.1 per 100,000 in 2011.
Thirty percent of deaths among children with epilepsy were caused by developmental conditions (ie, congenital malformations, chromosomal abnormalities, intellectual disability and cerebral palsy) and cardiovascular disorders excluding congenital malformations.
Cardiovascular disorders besides congenital malformations were a more common cause of death among older children, while infective heart disease was more likely to cause death among younger children.
Eleven percent of deaths among children with epilepsy were due to unintentional and undetermined injuries. Of these, 24% were side effects of therapeutic drugs and 16% were traffic injuries. An estimated 8% of deaths were due to epilepsy-specific causes.
“Team-based care coordination across medical and nonmedical systems can improve outcomes and reduce health care costs for children with special health care needs, but they require more study among children with epilepsy,” the researchers wrote.
November is National Epilepsy Awareness Month.
In an effort to improve access to coordinated care for children with epilepsy, The Health Resources and Services Administration funds community-based demonstration projects. Additionally, the CDC supports community-based resources and services for children with epilepsy and their families.
“Ensuring appropriate and timely health care and social services for children with epilepsy, especially those with complications, might reduce the risk for premature death,” according to researchers. “Health care providers, social service providers, advocacy groups and others can work together to assess whether coordinated care can improve outcomes for children with epilepsy.”
Disclosure: The researchers report no relevant financial disclosures.
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