Healthcare Utilisation and Mortality for People with Epilepsy during COVID-19: a population study

Abstract

Objective
To characterise changes in healthcare utilisation and mortality for people with epilepsy (PWE) during the COVID-19 pandemic.
Method
We performed a retrospective study using linked, individual-level, population-scale anonymised health data from the Secure Anonymised Information Linkage Databank. We identified PWE living in Wales during the study “pandemic period” (01/01/2020–30/06/2021) and during a “pre-pandemic” period (01/01/2016–31/12/2019).
We compared pre-pandemic healthcare utilisation, status epilepticus and mortality rates with corresponding pandemic rates for PWE and people without epilepsy (PWOE). We performed subgroup analyses on: children(<18), older people(>65), those with intellectual disability and those living in the most deprived areas. We used Poisson models to calculate adjusted rate ratios.
Results
We identified 27,279 PWE who had significantly higher rates of hospital (50.3 visits/1000 patient months), emergency department (55.7) and outpatient attendances (172.4) when compared to PWOE (corresponding figures: 25.7, 25.2 and 87.0) in the pre-pandemic period.
Hospital and epilepsy-related hospital admissions, emergency department and outpatient attendances all reduced significantly for PWE (and all subgroups) during the pandemic period. Rate ratios(RR),[95%CI] for pandemic vs pre-pandemic periods were: 0.70,[0.69–0.72];0.77,[0.73–0.81];0.78,[0.77–0.79] and 0.80,[0.79–0.81]). The corresponding rates also reduced for PWOE.
New epilepsy diagnosis rates decreased during the pandemic compared with the pre-pandemic period (2.3/100,000/month c.f 3.1/100,000/month, RR 0.73,[0.68–0.78]). Both all cause deaths and deaths with epilepsy recorded on the death certificate increased for PWE during the pandemic (RRs 1.07,[0.997–1.145] and 2.44,[2.12–2.81]). When removing COVID deaths RRs were:0.88,[0.81–0.95] and 1.29,[1.08–1.53]. Status epilepticus rates did not change significantly during the pandemic (0.95,[0.78–1.15]).
Significance
All cause non-COVID deaths did not increase but non-COVID deaths associated with epilepsy did increase for PWE during the COVID-19 pandemic. The longer-term effects of the decrease in new epilepsy diagnoses and healthcare utilisation and increase in deaths associated with epilepsy needs further research.

Rights

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0/

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Identifiers

DOI

https://doi.org/10.1111/epi.17920

Repository URI

https://www.research.ed.ac.uk/en/publications/d0a16277-1dbd-4a23-a003-1184e68eae6c