Abstract
PurposeThe COVID-19 pandemic has increased mortality worldwide and those with chronic conditions may have been disproportionally affected. However, it is unknown whether the pandemic has changed mortality rates for people with epilepsy. We aimed to compare mortality rates in people with epilepsy in Wales during the pandemic with pre-pandemic rates. MethodsWe performed a retrospective study using individual-level linked population-scale anonymised electronic health records. We identified deaths in people with epilepsy (DPWE), i.e. those with a diagnosis of epilepsy, and deaths associated with epilepsy (DAE), where epilepsy was recorded as a cause of death on death certificates. We compared death rates in 2020 with average rates in 2015–2019 using Poisson models to calculate death rate ratios. ResultsThere were 188 DAE and 628 DPWE in Wales in 2020 (death rates: 7.7/100,000/year and 25.7/100,000/year). The average rates for DAE and DPWE from 2015 to 2019 were 5.8/100,000/year and 23.8/100,000/year, respectively. Death rate ratios (2020 compared to 2015–2019) for DAE were 1.34 (95%CI 1.14–1.57, p<0.001) and for DPWE were 1.08 (0.99–1.17, p = 0.09). The death rate ratios for non-COVID deaths (deaths without COVID mentioned on death certificates) for DAE were 1.17 (0.99–1.39, p = 0.06) and for DPWE were 0.96 (0.87–1.05, p = 0.37). ConclusionsThe significant increase in DAE in Wales during 2020 could be explained by the direct effect of COVID-19 infection. Non-COVID-19 deaths have not increased significantly but further work is needed to assess the longer-term impact.
Highlights
Coronavirus disease 2019 (COVID-19) has had a devastating effect on people’s health and has resulted in increased mortality worldwide [1]
Death certificate and demographic data and analysed epilepsy-related deaths in two ways: Deaths associated with epilepsy (DAE) had an International Classi fication of Diseases version 10 (ICD10) code for epilepsy in any of the ten cause of death positions on death certificate data [9]; this included people who did not neces sarily receive a diagnosis of epilepsy before death
There was a significant increase in deaths associated with epilepsy (DAE) in Wales in 2020 compared with DAE 2015–2019
Summary
Coronavirus disease 2019 (COVID-19) has had a devastating effect on people’s health and has resulted in increased mortality worldwide [1] Those with chronic conditions, such as epilepsy, may be dis proportionally affected and more susceptible to COVID-19 hospital isation and death [2]. In addition to the direct effects of COVID-19, the pandemic has affected people with epilepsy in several ways These include the impact of COVID-19 on mental health, health services, and healthcare seeking behaviour [3,4]. Specialist epilepsy services in Wales adapted rapidly to restrictions imposed during the pandemic, where virtual (telephone and video) epilepsy clinics became the norm from March 2020 onwards This very significant restriction on face-to-face contact in specialist and pri mary care settings will have altered patient experience [4,5]. Our analysis will allow for further, more detailed, assessment of the impact of the second UK wave of Covid-19 infections on people living with epilepsy and the longer-term impact on mortality
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