Premature mortality in people with epilepsy in rural China: a prospective study.
BACKGROUND
In China, few studies have described annual mortality associated with epilepsy in a general population and these have provided a range of 3.0-7.9 deaths per 100,000 people. We calculated the case fatality rate (CFR), proportional mortality rate (PMR), and standardised mortality ratio (SMR) to assess mortality in people with epilepsy in rural China.


METHODS
The target population was people with epilepsy who participated in an assessment of epilepsy management at primary health level in rural China. Neurologists confirmed the diagnosis using strict criteria in all participants who were then treated with phenobarbital. Demographic data and putative cause of death were recorded for each person whose death was reported. PMRs for each cause of death and SMRs were estimated on the basis of the 2004 Chinese population.


RESULTS
Case fatality rate was 1.4% (35 deaths) among 2455 people with epilepsy. The age-adjusted PMRs for injury, stroke, neoplasm, myocardial infarction, and pneumonia were 30%, 30%, 15%, 6%, and 5%, respectively. The SMR was 3.9 (95% CI 3.8-3.9). Patients aged 15-29 years had higher mortality ratios than did those in other age-groups, with SMRs exceeding 23.


CONCLUSIONS
Risk for premature death is three to four times higher in people with epilepsy than in the general Chinese population. Furthermore, the risk in young people with epilepsy in China is much higher than previously reported. Injury, stroke, myocardial infarction, and pneumonia are among the leading putative causes of death in patients with epilepsy in rural China.
Ding
Ding
D
Department of Biostatistics and Epidemiology, Institute of Neurology, Fudan University, WHO Collaborating Centre for Research and Training in Neurosciences, Shanghai, China.
Wang
Wenzhi
W
Wu
Jianzhong
J
Ma
Guangyu
G
Dai
Xiuying
X
Yang
Bin
B
Wang
Taiping
T
Yuan
Chenglin
C
Hong
Zhen
Z
de Boer
Hanneke M
HM
Prilipko
Leonid
L
Sander
Josemir W
JW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D004827:Epilepsy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000627:therapeutic use; D011446:Prospective Studies; D012424:Rural Population; D014944:World Health Organization
D000927:Anticonvulsants; D010634:Phenobarbital