In a recent publication in the journal Epilepsia, researchers conducted a retrospective study to gain more insight into changes in the utilization of healthcare and mortality in patients with epilepsy (PWE) during the COVID-19 pandemic.
To conduct the study, researchers used linked, individual-level, population-scale anonymized health data on patients in Wales from the Secure Anonymised Information Linkage databank.
For the purpose of the study, the “pandemic period” was defined as January 1, 2020, to June 30, 2021, and the “prepandemic” period as January 1, 2016, to December 31, 2019. The researchers compared prepandemic healthcare utilization, status epilepticus, and mortality rates with corresponding pandemic rates for PWE and patients without epilepsy (PWOE).
A subgroup analysis of children (aged <18 years), older people (aged >65 years), those with intellectual disability, and those living in the most deprived areas was also conducted. To calculate adjusted rate ratios (RRs), the researchers employed Poisson models.
A total of 27,279 PWE were identified. The PWE study population had significantly higher rates of hospital (50.3 visits/1,000 patient-months), emergency department (55.7), and outpatient attendance (172.4) than PWOE (corresponding rates: 25.7, 25.2, and 87.0) in the prepandemic period.
Hospital and epilepsy-related hospital admissions, as well as emergency department and outpatient attendances, decreased significantly for PWE (and all subgroups) during the pandemic period. RRs (CI, 95%) for pandemic versus prepandemic periods were reported as .70 (.69-.72), .77 (.73-.81), .78 (.77-.79), and .80 (.79-.81). The corresponding rates were also reduced for PWOE.
The results also revealed that diagnosis rates for new epilepsy cases declined during the pandemic compared with the prepandemic period (2.3/100,000/month vs. 3.1/100,000/month, RR = .73; 95% CI, .68-.78).
During the pandemic, both all-cause mortality and mortality with epilepsy recorded on the death certificate for PWE increased (RR = 1.07; 95% CI, .997-1.145, and RR = 2.44; 95% CI, 2.12-2.81). When COVID-19 mortality was eliminated from analysis, RRs were 0.88 (95% CI; .81-.95) and 1.29 (95% CI, 1.08-1.53). During the pandemic, status epilepticus rates did not shift significantly (RR = .95; 95% CI, .78-1.15).
Based on their findings, the authors concluded that all-cause non-COVID mortality did not rise, but non-COVID mortality associated with epilepsy did rise for PWE during the COVID-19 pandemic.
The authors also noted that the longer-term effects of the reduction in new epilepsy diagnoses and healthcare utilization and the increase in the number of mortalities associated with epilepsy warrant additional research.
Finally, the authors wrote, “With increasing strain on health care services in the post-pandemic recovery period, these findings could have implications for PWE, health care professionals, and health care providers.”
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