title: Estimating the incidence of first unprovoked seizure and newly diagnosed epilepsy in the low-income urban community of Northern Manhattan, New York City.
abstract: OBJECTIVE
  To estimate the incidence and mortality associated with first unprovoked seizure or newly diagnosed epilepsy in a low-income, predominantly Hispanic community in Northern Manhattan, New York City.
  
  
  METHODS
  We performed a population-based study to determine the incidence of first unprovoked seizure or newly diagnosed epilepsy. Participants were Northern Manhattan residents seen at area hospitals and nursing homes between 2003 and 2005. Cumulative probability of mortality and standardized mortality ratios (SMRs) were also calculated.
  
  
  RESULTS
  Among 209 incident cases identified, 123 (58.9%) presented with an incident single unprovoked seizure. A total of 138 (66.0%) participants were Hispanic and 94 (45.0%) had a median household income under $15,000/year. The overall age and sex-adjusted incidence of all unprovoked seizures was 41.1 (95%CI = 35.4-46.8) per 100,000 person-years. Higher incidence was observed in low-income groups. Incidence among Hispanics was similar to that of non-Hispanic whites and non-Hispanic blacks. The cumulative probability of mortality was 17% (95%CI = 12-24%) by 3 years after diagnosis and was significantly greater in females and in those with an identified etiology. SMRs were significantly increased for all groups with respect to age, Hispanic ethnicity, middle and high income, partial seizure type, and remote symptomatic etiology. Idiopathic/cryptogenic and progressive symptomatic etiologies, low income, gender, and non-Hispanic ethnicity were not associated with a significantly increased SMR.
  
  
  CONCLUSIONS
  Incidence of first unprovoked seizure or newly diagnosed epilepsy did not differ by race-ethnicity. Although lower income was associated with higher incidence, higher income was associated with an increased SMR. Future research should examine reasons for differential incidence by income.
authors.affiliation: Gertrude H Sergievsky Center, Columbia University, New York, New York 10032, USA.
authors.forename: Emma K T
authors.initials: EK
authors.lastname: Benn
authors.forename: W Allen
authors.initials: WA
authors.lastname: Hauser
authors.forename: Tina
authors.initials: T
authors.lastname: Shih
authors.forename: Linda
authors.initials: L
authors.lastname: Leary
authors.forename: Emilia
authors.initials: E
authors.lastname: Bagiella
authors.forename: Peter
authors.initials: P
authors.lastname: Dayan
authors.forename: Robert
authors.initials: R
authors.lastname: Green
authors.forename: Howard
authors.initials: H
authors.lastname: Andrews
authors.forename: David J
authors.initials: DJ
authors.lastname: Thurman
authors.forename: Dale C
authors.initials: DC
authors.lastname: Hesdorffer
mesh_terms: D000328:Adult; D000368:Aged; D002391:Catchment Area, Health; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010865:Pilot Projects; D011159:Population Surveillance / Q000379:methods; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*