title: Premature mortality risk in people with convulsive epilepsy: long follow-up of a cohort in rural China.
abstract: OBJECTIVE
  Detailed data on the mortality of epilepsy are still lacking from resource-poor settings. We conducted a long-term follow-up survey in a cohort of people with convulsive epilepsy in rural areas of China. In this longitudinal prospective study we investigated the causes of death and premature mortality risk among people with epilepsy.
  
  
  METHODS
  We attempted to trace all 2,455 people who had previously participated in a pragmatic assessment of epilepsy management at the primary health level. Putative causes of death were recorded for those who died, according to the International Classification of Diseases. We estimated proportional mortality ratios (PMRs) for each cause, and standardized mortality ratios (SMRs) for each age-group and cause. Survival analysis was used to detect risk factors associated with increased mortality.
  
  
  RESULTS
  During 6.1 years of follow-up there were 206 reported deaths among the 1,986 people with epilepsy who were located. The highest PMRs were for cerebrovascular disease (15%), drowning (14%), self-inflicted injury (13%), and status epilepticus (6%), with probable sudden unexpected death in epilepsy (SUDEP) in 1%. The risk of premature death was 2.9 times greater in people with epilepsy than in the general population. A much higher risk (SMRs 28-37) was found in young people. Duration of epilepsy and living in a waterside area were independent predictors for drowning.
  
  
  CONCLUSIONS
  Drowning and status epilepticus were important, possibly preventable, causes of death. Predictors of increasing mortality suggest interventions with efficient treatment and education to prevent premature mortality among people with epilepsy in resource-poor settings.
authors.affiliation: Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Ding
authors.forename: Wenzhi
authors.initials: W
authors.lastname: Wang
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Wu
authors.forename: Hongchao
authors.initials: H
authors.lastname: Yang
authors.forename: Shichuo
authors.initials: S
authors.lastname: Li
authors.forename: Xiuying
authors.initials: X
authors.lastname: Dai
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.forename: Taiping
authors.initials: T
authors.lastname: Wang
authors.forename: Chenglin
authors.initials: C
authors.lastname: Yuan
authors.forename: Guangyu
authors.initials: G
authors.lastname: Ma
authors.forename: Gail S
authors.initials: GS
authors.lastname: Bell
authors.forename: Patrick
authors.initials: P
authors.lastname: Kwan
authors.forename: Hanneke M
authors.initials: HM
authors.lastname: de Boer
authors.forename: Zhen
authors.initials: Z
authors.lastname: Hong
authors.forename: Josemir W
authors.initials: JW
authors.lastname: Sander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D004829:Epilepsy, Generalized / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature / Q000639:trends*; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000639:trends*; D055815:Young Adult