Rationale:
Mortality is elevated in people with epilepsy (PWE) compared to the general population. Cardiovascular disease and cancer remain leading causes of morbidity and mortality in the United States. Cigarette smoking is one of the leading causes of preventable cardiopulmonary disease. Previous studies have shown that smoking is more common in PWE compared to the general population; and, while the rates of smoking have decreased significantly over time among the general population, declines among PWE have not been substantial up through 2017. Additionally, there is a lack of data on the utilization of health screening behaviors among people with epilepsy. The goal of this project is to examine differences among smoking and cancer screening among people with and without epilepsy, to examine some potential contributors to non-seizure-related mortality.
Methods:
Data was retrieved from the 2021 National Health Information Survey (NHIS) which surveyed 26,742 participants (representing 246 million individuals) in 50 states and the District of Columbia. Similar to the CDC, we defined “active epilepsy” as a self-reported diagnosis of a seizure disorder or epilepsy and either self-reported medication to treat epilepsy, or having had ≥ 1 seizure in the past year. We used chi-square comparisons and logistic regression to compare self-reported smoking status (current, former, never) and cancer screenings (pap smears, colonoscopies, mammograms) in people with and without epilepsy. We adjusted results for age, sex, race, ethnicity, and socioeconomic status.
Results:
A total of 1.1% of the study population had active epilepsy. People with epilepsy (PWE) were more likely to be current daily smokers compared to people without epilepsy (13.7% vs 8.5%, p=0.006). Among PWE, smoking was more common with those that have more frequent seizures. For instance, among PWE with two to three seizures in the past year, 30% were current smokers compared to 38% never smokers. In contrast, of PWE with no seizures in the past year, 13% were current smokers compared to 58% never smokers (p=0.021). PWE and people without epilepsy had similar rates of having had appropriate screenings for pap smears (83% versus 81%, p=0.610), colonoscopies (77% versus 70%, p=0.112), and mammograms (92% versus 90%, p=0.630). The likelihood of having had appropriate cancer screenings remained similar after adjusting for demographics.
Conclusions:
While people with epilepsy tend to report economic disadvantages and reduced health-related quality of life, and have elevated mortality compared to the general population, PWE often have frequent contact with healthcare services. This increase in interfaces with the healthcare system may contribute to appropriate access to cancer screenings. Healthcare providers should be aware of the need to discuss smoking status and cessation resources, particularly among patients with uncontrolled epilepsy, as smoking is a major contributor to cardiovascular and pulmonary disease. Overall, continued provider focus on the prevention, early intervention, and treatment of comorbid conditions may lead to improved health outcomes in people with epilepsy.
Funding: The NHIS is funded by the CDC.