Early View
FULL‐LENGTH ORIGINAL RESEARCH

Mortality and morbidity of patients with treated and untreated epilepsy in New Zealand

Kristen Joy Hamilton

Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia

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Zhibin Chen

Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia

Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia

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Andrew Tomlin

Best Practice Advocacy Centre New Zealand, Dunedin, New Zealand

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Patrick Kwan

Corresponding Author

E-mail address: patrick.kwan@monash.edu

Department of Medicine at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia

Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia

Correspondence

Patrick Kwan, Department of Neuroscience, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia.

Email: patrick.kwan@monash.edu

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First published: 24 January 2020
The statistical analysis was conducted by Zhibin Chen at Monash University.

Abstract

Objective

To investigate whether delayed or no treatment was associated with increased mortality and morbidity risks in people with newly diagnosed epilepsy.

Methods

We examined New Zealand hospitalization and antiseizure medication prescription data from 2007‐2015. Mortality and hospital‐diagnosed morbidities were compared between patients immediately treated after epilepsy diagnosis, treated after a delay, or untreated for the duration of follow‐up, adjusted for age, sex, and ethnicity.

Results

Three thousand three hundred sixty‐six patients (54.7% male, median age = 37.5 years) were included and followed up for a median of 3.39 years. A total of 3123 (92.8%) patients were treated immediately, 125 (3.7%) had delayed treatment, and 118 (3.5%) were untreated. Compared to the general New Zealand population, the cohort had a standardized mortality ratio of 4.60 (95% confidence interval [CI] = 4.24‐4.99). Maori patients were less likely to be treated (Holm‐Bonferroni adjusted P = .024) and had higher mortality (hazard ratio [HR] = 1.41, 95% CI = 1.08‐1.83). There was a trend of increased mortality in the untreated or delayed treatment group compared to the immediate treatment group (HR = 1.36, 95% CI = 0.99‐1.87). Hospitalization risk was similar between untreated and immediately treated periods (P = .83). Untreated or delayed treatment patients had higher risk of acute myocardial infarction (HR = 9.64, 95% CI = 1.83‐50.8). Maori patients were more likely to develop liver disease (HR = 4.67, 95% CI = 1.32‐16.4) and alcohol or drug dependence (HR = 2.55, 95% CI = 1.44‐4.51).

Significance

Most epilepsy patients were treated at diagnosis in New Zealand, but Maori patients had lower treatment rates and worse health outcomes. The apparent increased risk of acute myocardial infarction among the untreated or delayed treatment patients warrants further research.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.

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