Authors :
Presenting Author: Vikas Singh, MD, MHSA, FAES – Kansas City VA Medical Center, Kansas University Medical Center
Jason Obermann, MD – Psychiatry – University of Kansas Medical Center; Krishna Divadeenam, MD – Psychiatry – Kansas City VA Medical Center; Siddarth Sharma, MPH – George Washington University; Supriya Muppala, BA – University of Pennsylvania; Mukut Sharma, PhD – Kansas City VA Medical Center; Thomas Wiegmann, MD – Kansas City VA Medical Center; Ram Sharma, PhD – Kansas City VA Medical Center
Rationale: There is increased prevalence of various MHC including substance abuse in patients with epilepsy as compared to the general population. The numbers are thought to be even higher in Veterans with epilepsy
(VWE). Previous studies have focused on ambulatory settings for assessing healthcare utilization and outcomes in this population. In this study we
focused on outcomes and interaction between epilepsy, MHC, substance use and TBI amongst veterans hospitalized for acute MHC.
Methods: We utilized the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database which includes clinical and administrative records to identify veterans admitted to VA medical centers from January 1, 2000 to December 31, 2020 with an admitting diagnosis of various
MHC and controls. ICD 9 and 10 codes were used to identify veterans with epilepsy, TBI and MHC. MHC comprise psychosis, bipolar spectrum, schizophrenia, depressive disorders, and PTSD. Substance abuse was identified by laboratory records review.
Frequency data were grouped for calculations of Odds ratios (OR) to determine the effect of epilepsy on various factors such as age < > 50 years, race white vs non-white, admissions grouping on a scale of 0-9 vs greater than 10, all-cause mortality (alive vs dead), suicide attempts and suicide outcomes. Co-morbidities and drug use were grouped as absent (no) or present (yes) (Table 1 and 2). SAS (Enterprise Guide 8.2) was used for statistical analysis.
Results: Our cohort consisted of 312,625 veterans (48.94% with MHC and 51.06% control) who were predominantly male (94%), younger than 50 years of age (~73%), with almost equal split between white and non-white races and with majority followed for
>3650 days to assess outcomes (Table 1). The OR for gender, age group and race was significant but small (OR 0.91 to 1.21). VWE had much higher and significant odds of separate additional comorbid MHC (OR 3.38 to 13.21, Table 2). VWE in this cohort had OR of 8.21 of TBI as compared to controls. Similarly, VWE had significantly higher odds of substance use (OR 2.53 to 5.27, Table 2). VWE in this cohort were almost five times more likely to attempt suicide (OR 4.87) with higher completion rate as compared to controls (OR 1.4); had slightly higher mortality (OR 1.17) and higher rates of admissions (OR 1.5, Table 2).
Conclusions: In this cohort of hospitalized veterans, VWE had a much higher incidence of comorbid, multiple MHC, TBI, substance use, suicide attempts and suicide completion rate as well as all-cause mortality. The prevalence of VWE (2.53%) in this entire cohort was much higher than the general population in US (1.2%) with higher rates of acute health care utilization. These may be secondary to complex and often bidirectional interactions between epilepsy, epilepsy induced mood disorders and comorbid MHC, TBI, and substance use. Additional work is needed to parse out these complex interactions.
Funding: Midwest Veterans Biomedical Research Foundation