Sociodemographic disparities in administration of antiepileptic drugs to adults with epilepsy in Germany: a retrospective, database study of drug prescriptions.

Abstract

Large epidemiological databases facilitate the study of medical care in different subgroups of the population and how such care compares with standard treatment guidelines. This study aimed for such analyses regarding utilization of antiepileptic drugs (AEDs) for epilepsy in Germany. The data source was the Disease Analyzer(®) database that is representative for the German population and assembles anonymous demographic and medical (diagnoses, prescriptions) data obtained from the practice computer system of general practitioners and specialists throughout Germany. A total of 43,712 adult patients with an epilepsy diagnosis (International Classification of Diseases, 10th edition [ICD10] code: G40.X) seen in 2010-2012 by 346 neurologists were retrospectively analysed according to sociodemographic characteristics, comorbidity, and AED treatment. Multivariate logistic regression was applied to calculate adjusted odds ratios (ORs) with 95 % confidence intervals (CIs). As compared with women, men were less likely to receive lamotrigine (OR 0.68; 95 % CI 0.65-0.72; p < 0.001) and were treated preferably with carbamazepine (OR 1.29; 95 % CI 1.23-1.35; p < 0.001). As compared with patients covered by private health insurance (PHI), patients with statutory health insurance (SHI) were treated more often with valproate (OR 1.19; 95 % CI 1.07-1.31; p < 0.001) and showed a higher rate of obesity (SHI: 3.1 %; PHI: 1.6 %; p < 0.001), while PHI was associated with administration of levetiracetam (OR 1.27; 95 % CI 1.16-1.4; p < 0.001). Carbamazepine (OR 1.25; 95 % CI 1.17-1.31; p < 0.001) and primidone (OR 1.23; 95 % CI 1.08-1.38; p < 0.001) were administered to a larger extent in rural versus urban areas. Lamotrigine (OR 1.31; 95 % CI 1.23-1.39; p < 0.001) was used more often in West than in East Germany. Living in an urban community raised the likelihood of being treated with levetiracetam (OR 1.23; 95 % CI 1.17-1.28; p < 0.001). In spite of common guidelines, AED treatment differed significantly among adults with epilepsy in Germany. Besides gender, type of health insurance and place of residence strongly influenced AED administration.