Importance:
People with epilepsy are at increased risk of mortality, but, to date, the cause-specific risks of all unnatural causes have not been reported.
Objective:
To estimate cause-specific unnatural mortality risks in people with epilepsy and to identify the medication types involved in poisoning deaths.
Design, Setting, and Participants:
This population-based cohort study used 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014). Each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy. Unnatural mortality was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records. Hazard ratios (HRs) were estimated in each data set using a stratified Cox proportional hazards model, and meta-analyses were conducted using DerSimonian and Laird random-effects models. The analysis was performed from January 5, 2016, to November 16, 2017.
Exposures:
People with epilepsy were identified using primary care epilepsy diagnoses and associated antiepileptic drug prescriptions.
Main Outcomes and Measures:
Hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths.
Results:
In total, 44678 individuals in the CPRD and 14 051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891 429 (CPRD) and 279 365 (SAIL) individuals were identified in the comparison cohorts. In both data sets, 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts. People with epilepsy were significantly more likely to die of any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) than people in the comparison cohort. Particularly large risk increases were observed in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53). Opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] were more commonly involved than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy.
Conclusions and Relevance:
Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.
Hayley C Gorton, Roger T Webb, Mathew J Carr, Marcos Delpozo-Banos, Ann John, Darren M Ashcroft, Risk of Unnatural Mortality in People With Epilepsy. JAMA Neurology, 75(8), 929-038, 2018.
Code | Description | Entity type | Category | Coding System (Read) |
---|---|---|---|---|
a81.. | codeine phosphate [git] | res55: opioid | drug | Read |
a811. | codeine phosphate 15mg tablets | res55: opioid | drug | Read |
a812. | codeine phosphate 30mg tablets | res55: opioid | drug | Read |
a813. | codeine phosphate 60mg tablets | res55: opioid | drug | Read |
dia1. | *aspirin/paracet/codeine tabs | res55: opioid | drug | Read |
dia2. | co-codamol 8mg/500mg tablets | res55: opioid | drug | Read |
dia3. | co-codamol 8mg/500mg disp tabs | res55: opioid | drug | Read |
dia6. | co-dydramol tablets | res55: opioid | drug | Read |
dia7. | *co-proxamol tablets | res55: opioid | drug | Read |
diaI. | *paracet+codeine 500/30mg/sach | res55: opioid | drug | Read |
diaJ. | *kapake insts 500mg/30mg/sach | res55: opioid | drug | Read |
diaL. | *kapake insts 1000mg/60mg pdr | res55: opioid | drug | Read |
diaT. | codipar caplets | res55: opioid | drug | Read |
diaU. | paracet+codeine 500/15mg tabs | res55: opioid | drug | Read |
diam. | kapake tablets | res55: opioid | drug | Read |
dian. | paracet+codeine 500/30mg tabs | res55: opioid | drug | Read |
diao. | kapake capsules | res55: opioid | drug | Read |
diap. | co-codamol 8mg/500mg eff tabs | res55: opioid | drug | Read |
diaq. | co-codamol 8mg/500mg capsules | res55: opioid | drug | Read |
dib3. | *medocodeine tablets | res55: opioid | drug | Read |
dibD. | paracet+codeine 500/30mg caps | res55: opioid | drug | Read |
dibG. | tylex effervescent sol.tabs | res55: opioid | drug | Read |
dibJ. | *remedeine forte eff tabs | res55: opioid | drug | Read |
dibK. | *remedeine eff tabs | res55: opioid | drug | Read |
dibR. | solpadeine max tablets | res55: opioid | drug | Read |
dibS. | solpadol capsules | res55: opioid | drug | Read |
dibn. | solpadeine soluble eff tabs | res55: opioid | drug | Read |
dibo. | *solpadeine forte disp tabs | res55: opioid | drug | Read |
dibt. | tylex 500mg capsules | res55: opioid | drug | Read |
dibu. | solpadol effervescent tablets | res55: opioid | drug | Read |
dibv. | remedeine tablets | res55: opioid | drug | Read |
dibw. | remedeine forte tablets | res55: opioid | drug | Read |
dibz. | solpadol caplets | res55: opioid | drug | Read |
dic3. | zapain caplets | res55: opioid | drug | Read |
dic4. | zapain capsules | res55: opioid | drug | Read |
dicJ. | solpadeine headache tablets | res55: opioid | drug | Read |
dicK. | solpadeine headache sol tabs | res55: opioid | drug | Read |
dicN. | *kapake 30/500 eff tablets | res55: opioid | drug | Read |
dicO. | tramacet 325mg/37.5mg tablets | res55: opioid | drug | Read |
dicY. | tramacet 325mg/37.5mg eff tabs | res55: opioid | drug | Read |
dica. | codipar 15mg/500mg eff tabs | res55: opioid | drug | Read |
dj1.. | morphine salts(1) [cns] | res55: opioid | drug | Read |
dj2.. | morphine analgesic elixirs | res55: opioid | drug | Read |
dj3.. | buprenorphine | res55: opioid | drug | Read |
dj4.. | codeine phosphate [analgesic] | res55: opioid | drug | Read |
dj5.. | dextromoramide | res55: opioid | drug | Read |
dj6.. | dextropropoxyphene hcl | res55: opioid | drug | Read |
dj7.. | diamorphine hcl [analgesic] | res55: opioid | drug | Read |
dj8.. | dihydrocodeine tartrate | res55: opioid | drug | Read |
dj9.. | dipipanone hydrochloride | res55: opioid | drug | Read |
djA.. | tramadol (2) | res55: opioid | drug | Read |
djB.. | tapentadol | res55: opioid | drug | Read |
dja.. | *levorphanol tartrate [cns] | res55: opioid | drug | Read |
djb.. | meptazinol [analgesic] | res55: opioid | drug | Read |
djc.. | methadone hcl [analgesic] | res55: opioid | drug | Read |
djd.. | nalbuphine hydrochlor [cns] | res55: opioid | drug | Read |
dje.. | *papaveretum [cns narcotic] | res55: opioid | drug | Read |
djf.. | pentazocine | res55: opioid | drug | Read |
djg.. | pethidine hydrochlor [analg] | res55: opioid | drug | Read |
djh.. | phenazocine hydrobromide | res55: opioid | drug | Read |
dji.. | tramadol | res55: opioid | drug | Read |
djj.. | hydromorphone hydrochloride | res55: opioid | drug | Read |
djk.. | oxycodone hydrochloride | res55: opioid | drug | Read |
djm.. | oxycodone hydrochloride (2) | res55: opioid | drug | Read |
djy.. | morphine salts(3) [cns] | res55: opioid | drug | Read |
djz.. | morphine salts(2) [cns] | res55: opioid | drug | Read |
dl11. | migraleve duo-pack tablets | res55: opioid | drug | Read |
dl12. | migraleve pink tablets | res55: opioid | drug | Read |
dl13. | migraleve yellow tablets | res55: opioid | drug | Read |
dl14. | *migravess dispersible tablets | res55: opioid | drug | Read |
dl15. | *migravess forte tablets | res55: opioid | drug | Read |
dl18. | migraleve duo-pack tablets x48 | res55: opioid | drug | Read |
dl19. | migraleve pink tablets x48 | res55: opioid | drug | Read |
dl1a. | *migraleve yellow tablets x48 | res55: opioid | drug | Read |
j28O. | ibupro+codeine 200/12.5mg tabs | res55: opioid | drug | Read |
j28V. | ibupro+codeine 200/12.8mg tabs | res55: opioid | drug | Read |
j28z. | *ibupr+codein 300/20mg m/r tab | res55: opioid | drug | Read |
j2pT. | solpadeine migraine ibu+cod | res55: opioid | drug | Read |
o41.. | alfentanil | res55: opioid | drug | Read |
o42.. | fentanyl | res55: opioid | drug | Read |
o44.. | meptazinol [anaesthesia] | res55: opioid | drug | Read |
o45.. | morphine salts [anaesthesia] | res55: opioid | drug | Read |
o46.. | nalbuphine hydrochl [anaesth] | res55: opioid | drug | Read |
o47.. | papaveretum [anaesthesia] | res55: opioid | drug | Read |
o48.. | pethidine hydrochlor [anaesth] | res55: opioid | drug | Read |
o49.. | phenoperidine hydrochloride | res55: opioid | drug | Read |
o4c.. | remifentanil | res55: opioid | drug | Read |
o4d.. | fentanyl (2) | res55: opioid | drug | Read |
o4e.. | fentanyl (3) | res55: opioid | drug | Read |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH471/version/942/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH471/version/942/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH471/version/942/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH471/version/942/export/codes/?format=json |
CSV | site_root/phenotypes/PH471/version/942/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
942 | Opioid | ieuan.scanlon | 2021-10-06 | currently shown |
Export - export all codes into a csv file/JSON/XML for the current phenotype version.
Print - Print page.