title: Population-based comparative analysis of risk of death in children and adolescents with epilepsy and migraine.
abstract: OBJECTIVE
  Follow-up studies of children and adolescents with epilepsy (CAW-E) have revealed higher risk of mortality than children in the general population. The mortality experience of CAW-E relative to patients with other common neurologic disorders in the pediatric age group is yet undetermined. The objectives of this study are the following: (1) to compare the causes and the adjusted risk of death in CAW-E with that of children and adolescents with migraine (CAW-M) in reference to children and adolescents with lower extremity fracture (CAW-LEF), and children and adolescents in the general population; (2) to evaluate if disparate mortality risks exist by demographic characteristics.
  
  
  METHODS
  This retrospective cohort study included 56,781 children and adolescents 0-18 years of age hospitalized or treated in an emergency or outpatient department from 2000 to 2011 for epilepsy, migraine, or lower extremity fracture from all nonfederal health care facilities. Data on deaths were acquired from linked multiple causes of death data file using person-specific unique identifiers. Time of follow-up was from initial clinical encounter to time of death or censoring date of December 31, 2011. The association of risk characteristics with mortality was examined with Cox proportional hazard model after adjusting for potential confounders.
  
  
  RESULTS
  Four hundred forty-seven CAW-E and 125 CAW-M died yielding mortality rates of 8.71 and 1.36 per 1,000 person-years, respectively. The 5-year risk of death was 4.38% for CAW-E, 0.68% for CAW-M, and 0.71% for CAW-LEF. Adjusted hazard ratios (HRs) were 3.81 (95% confidence interval [CI] 3.08-3.72) in CAW-E and 1.14 (95% CI 0.94-1.34) in CAW-M relative to CAW-LEF. Risk of death from neurodevelopmental comorbidities was 5.86 (95% CI 4.24-8.08) times greater than those without in the model that compared epilepsy with LEF.
  
  
  CONCLUSIONS
  There is an elevated risk of death in CAW-E with neurodevelopmental comorbidities that remains to be proven.
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
authors.forename: Anbesaw W
authors.initials: AW
authors.lastname: Selassie
authors.affiliation: Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
authors.forename: Dulaney A
authors.identifier: http://orcid.org/0000-0003-4726-7848
authors.initials: DA
authors.lastname: Wilson
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
authors.forename: Janelle L
authors.initials: JL
authors.lastname: Wagner
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
authors.forename: Gigi
authors.initials: G
authors.lastname: Smith
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
authors.forename: Braxton B
authors.initials: BB
authors.lastname: Wannamaker
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008881:Migraine Disorders / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013022:South Carolina / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Children and adolescents; Comorbidities; Epilepsy and migraine; Risk of death