Abstracts

Rationale: Several studies have shown that persons with epilepsy (PWE) who are uninsured or on Medicaid do not have access to proper epilepsy care. Nonetheless, data on mortality in this vulnerable subpopulation are largely lacking. This study was designed to examine mortality and causes of death (COD) in socioeconomically disadvantaged PWE. Methods: We performed a retrospective open cohort analysis using Ohio Medicaid claims data between 1992 and 2008 to assess mortality and COD in 68,785 adult Medicaid beneficiaries with epilepsy. Case fatality (CF), mortality rates (MRs), standardized mortality ratios (SMRs), and years of potential life lost (YPLL) were calculated. The SMRs were estimated to compare risk of death in PWE with that in the general Medicaid population with and without disabilities. Proportionate mortality ratios (PMRs), YPLLs, and SMRs for specific COD were also obtained. Results: There were 12,630 deaths in PWE. CF was 18.4%, the age-race-sex adjusted MR was 18.6/1,000 person-years (95% CI, 18.3-18.9). The SMR was 1.8 (95% CI, 1.8 - 1.9) when compared to the general Medicaid population, and was 1.4 (95% CI, 1.3-1.6) when compared to those with disabilities. The average YPLL was 16.9 years (range, 1-47 years). Both epilepsy and comorbid conditions significantly contributed to premature mortality in PWE. Cardiovascular diseases, cancer, and unintentional injuries were the most common COD and account for a large proportion of YPLL. Deaths from epilepsy-related causes occurred in about 10% of the cases. Conclusions: Socioeconomically deprived PWE, especially young adults, experience high mortality and died 17 years prematurely. The high mortality in Medicaid beneficiaries with epilepsy affirms that those with epilepsy are among the sickest of all Medicaid enrollees. Comorbid conditions and epilepsy play a crucial role in premature death. Management of comorbid conditions is, at a minimum, as important as epilepsy management, and therefore deserves more attention from physicians, particularly those who care for Medicaid individuals with epilepsy.