Excess health care use is significantly and persistently reduced following diagnosis of late‐onset epilepsy

Abstract

AbstractObjectiveThe incidence of late‐onset epilepsy (LOE) is rising, and these patients may use an excess of health care resources. This study aimed to measure pre‐/post‐diagnostic health care use (HCU) for patients with LOE compared to controls.MethodsThis was an observational open cohort study covering years 1998–2019 using UK population‐based linked primary care (Clinical Practice Research Datalink [CPRD]) and hospital (HES) electronic health records. The participants included patients with incident LOE enrolled in CPRD and 1:10 age‐, sex‐, and general practice–matched controls. The exposure was incident LOE (diagnosed at age ≥65) using a 5‐year washout. The main outcome was all HCU (primary care [PC], accident and emergency [A&E], admitted patient and outpatient care) using inverse proportional weighting to PC use and HCU by setting. An interrupted time‐series analysis was used to examine pre‐/post‐diagnostic HCU between patients with LOE and controls over 4 years either side of diagnosis/matching date. An adjusted mixed‐effects negative binomial regression was used for post‐diagnosis HCU interactions.ResultsOf 2 569 874 people ≥65 years of age, 1048 (4%) developed incident LOE. Mean weighted total HCU increased by 32 visits per patient‐year (95% confidence interval [95% CI]: 13–50, p = .003) until LOE diagnosis, and then dropped by a mean of 60 visits per patient‐year (95% CI: −81 to −40). There was an acute rise and fall over the 1–2 years immediately pre‐/post‐diagnosis. Incident HCU remained higher for LOE compared to controls post‐diagnosis (adjusted incidence rate ratio: 1.72; 95% CI: 1.65–1.70; p < .001), including A&E, outpatient, and admitted care.SignificanceHealth care use demonstrates an acute on chronic rise over the 4 years before diagnosis of LOE. To what extent the partial reversal of the acute pre‐diagnosis rise, and the mediators of the accelerated increase compared to controls are attributed to epilepsy, comorbid and bidirectional disease states, or a combination of both warrants further exploration.