title: Epilepsy, excess deaths and years of life lost from external causes.
abstract: We systematically quantified excess mortality in epilepsy patients by cause of death using the population-attributable fraction and epilepsy-attributable years of potential life lost (YPLL) by age 75 years at ages 15 and over. We updated and undertook a re-review of mortality studies from our previous systematic review following PRISMA guidelines to identify cohort studies of general epilepsy populations reporting a relative risk (RR) of death by cause relative to the background rates in the population. Studies on epilepsy prevalence were identified through published reviews. Country-specific mortality figures were obtained from the WHO World Mortality Database. We performed a pooled analysis with the DerSimonian-Laird random effects method. In countries with very high Human Development Indices, epilepsy contributed to 0.5-1.1 % of all deaths in the total population. Among external causes, suicides (RR 2.9, 95 % confidence interval 2.2-3.8; I(2) 52 %) were the major contributor to YPLL, corresponding to 6.7 % and 4.2 % of excess YPLL due to epilepsy in the United States (US) and in the United Kingdom (UK) in 2010, with 541 (346-792) and 44 (28-65) excess suicide cases, respectively. Fatal accidental falls were more common, with 813 (610-1064) and 95 (71-125) excess deaths in the US and in the UK, but these caused only 2.0 % of excess YPLL as they occurred in older age groups. Suicides were the most important external cause of death in epilepsy patients in terms of excess YPLL, whereas other external causes were either more common in older ages or caused less excess deaths.
authors.affiliation: Hatanpää Health Center, Tampere, Finland. olli.neval@gmail.com.|School of Health Sciences, University of Tampere, Tampere, Finland. olli.neval@gmail.com.
authors.forename: Olli
authors.initials: O
authors.lastname: Nevalainen
authors.affiliation: Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Simola
authors.affiliation: Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Ansakorpi
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.|UKK Institute for Health Promotion, Tampere, Finland.
authors.forename: Jani
authors.initials: J
authors.lastname: Raitanen
authors.affiliation: Finnish Cancer Registry, Helsinki, Finland.
authors.forename: Miia
authors.initials: M
authors.lastname: Artama
authors.affiliation: Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.|Lundbeck, Deerfield, IL, USA.
authors.forename: Jouko
authors.initials: J
authors.lastname: Isojärvi
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.|Pediatric Research Center, Tampere University Hospital and University of Tampere, Tampere, Finland.
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
mesh_terms: D000368:Aged; D002423:Cause of Death; D017281:Cost of Illness; D004827:Epilepsy / Q000401:mortality*; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
keywords: Epidemiology; Epilepsy; Meta-analysis; Mortality