The Risk of COVID Hospitalisations and Deaths in People with Epilepsy, a Population Study
Abstract number :
2.389
Submission category :
17. Public Health
Year :
2022
Submission ID :
2204151
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:23 AM
Authors :
Huw Strafford, MSci – Swansea University; Arron Lacey, PhD – Medical School – Swansea University; Ashley Akbari, MSc – Medical School – Swansea University; Joe Hollinghurst, PhD – Medical School – Swansea University; Alan Watkins, PhD – Medical School – Swansea University; Angie Pullen, MSc, MPH – Epilepsy Action; Jan Paterson, BA – Epilepsy Action; Daniel Jennings, BSc – Epilepsy Action; Mike Kerr, MBChB – School of Medicine – Cardiff University; Rob Powell, PhD – Medical School – Swansea University; Ronan Lyons, OBE, FmedSci, FLSW, FFPH, MD – Medical School – Swansea University; Richard Chin, PhD – Child Life and Health and Centre for Clinical Brain Sciences – The University of Edinburgh; W Owen Pickrell, PhD – Medical School – Swansea University
Rationale: Coronavirus disease 2019 (COVID-19) has had a devastating effect on people’s health and has resulted in increased mortality worldwide. There is some evidence that people with epilepsy are at an increased risk of severe COVID. It is important to characterise this risk as accurately as possible to inform people with epilepsy and for future health and care planning. As part of the COVID-19 and Epilepsy in Wales (COVEW) project we aimed to assess, at a population level, whether people with epilepsy were more at risk of being hospitalised with, and dying from, COVID-19.
Methods: We performed a retrospective cohort study using linked, individual-level, population-scale anonymized electronic health records (EHR) from the Secure Anonymised Information Linkage (SAIL) Databank (www.saildatabank.com). This includes hospital admission and demographic data for the complete Welsh population (3.1 million) and primary care records for 85% (2.6 million) of the Welsh population.
We identified people with epilepsy (using primary care epilepsy diagnosis and anti-seizure medication (ASM) prescription codes) living in Wales during the study period (March 1, 2020 – June 30, 2021). We created a corresponding control cohort using exact 5:1 matching (sex, age, and socio-economic status).
We defined COVID-19 deaths as having an ICD-10 code for COVID-19 on death certificates and COVID-19 hospitalisations as having an COVID-19 ICD-10 code for the reason for admission, or hospitalisations within 28 days of a positive SARS-CoV-2 polymerase chain reaction test. We recorded 41 categories of comorbidities known to increase the risk of COVID-19 hospitalisations and deaths (including intellectual disability, dementia, diabetes) as covariates based on the QCOVID algorithm [Int J Popul Data Sci. 2022;5(4):1697]. We also recorded COVID-19 vaccination status. We used Cox-proportional hazard models to calculate hazard ratios.
Results: There were 27,279 people in the epilepsy (case) cohort and 136,395 people in the control cohort. There were 158 COVID-19 deaths and 933 COVID-19 hospitalisations in the epilepsy cohort, with corresponding numbers of 370 and 1871 in the control cohort. Comparing people with epilepsy to controls, the hazard ratios for COVID-19 deaths and COVID-19 hospitalisations were 2.15 (95% CI, 1.78-2.59) and 2.15 (1.94-2.37) respectively. Adjusted hazard ratios (adjusted for comorbidities associated with COVID-19 hospitalisations and COVID-19 deaths) for COVID-19 deaths and hospitalisations were 1.33 (1.08-1.63) and 1.60 (1.44-1.78). Identification of particular at-risk subgroups and assessment of the effect of vaccinations are ongoing.
Conclusions: People with epilepsy 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 prioritising future COVID treatments and vaccinations for people with epilepsy.
Funding: This work was funded by a Health and Care Research Wales Health Research Grant HRG-20-1725(P).
Public Health