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Abstract
Objective To determine the impact of socioeconomic status (SES) on sudden unexpected death in epilepsy (SUDEP) rates.
Methods We queried all decedents presented for medico-legal investigation at 3 medical examiner (ME) offices across the country (New York City, Maryland, San Diego County) in 2009 to 2010 and 2014 to 2015. We identified all decedents for whom epilepsy/seizure was listed as cause/contributor to death or comorbid condition on the death certificate. We then reviewed all available reports. Decedents determined to have SUDEP were included for analysis. We used median income in the ZIP code of residence as a surrogate for SES. For each region, zip code regions were ranked by median household income and divided into quartiles based on total population for 2 time periods. Region-, age-, and income-adjusted epilepsy prevalence was estimated in each zip code. SUDEP rates in the highest and lowest SES quartiles were evaluated to determine disparity. Examined SUDEP rates in 2 time periods were also compared.
Results There were 159 and 43 SUDEP cases in the lowest and highest SES quartiles. ME-investigated SUDEP rate ratio between the lowest and highest SES quartiles was 2.6 (95% confidence interval [CI] 1.7–4.1, p < 0.0001) in 2009 to 2010 and 3.3 (95% CI 1.9–6.0, p < 0.0001) in 2014 to 2015. There was a significant decline in overall SUDEP rate between the 2 study periods (36% decrease, 95% CI 22%–48%, p < 0.0001).
Conclusion ME-investigated SUDEP incidence was significantly higher in people with the lowest SES compared to the highest SES. The difference persisted over a 5-year period despite decreased overall SUDEP rates.
Glossary
- ASD=
- antiseizure drug;
- BMI=
- body mass index;
- CDC=
- Centers for Disease Control and Prevention;
- CI=
- confidence interval;
- IRR=
- incident rate ratio;
- MD=
- Maryland;
- ME=
- medical examiner;
- NYC=
- medical examiner;
- PWE=
- people with epilepsy;
- RR=
- rate ratio;
- SDC=
- San Diego County;
- SES=
- socioeconomic status;
- SUDEP=
- sudden unexpected death in epilepsy
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received April 9, 2019.
- Accepted in final form December 5, 2019.
- © 2020 American Academy of Neurology
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