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Premature Mortality of Epilepsy in Low- and Middle-income Countries: A Systematic Review from the Mortality Task Force of the International League Against Epilepsy
- Source :
- Epilepsia
- Publication Year :
- 2017
- Publisher :
- Blackwell Science, 2017.
-
Abstract
- Objectives To determine the magnitude, risk factors and causes of premature mortality associated with epilepsy in low and middle income countries (LMIC). Methods We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank-defined LMIC. We assessed the quality of the studies based upon representativeness, ascertainment of cases, diagnosis, and mortality, and extracted data on standardized mortality ratios (SMR) and mortality rates in people with epilepsy. We examined risk factors and causes of death. Results The annual mortality rate was estimated at 19.8 (range 9.7-45.1) deaths per 1000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3-7.2) among higher-quality population-based studies. Clinical cohort studies yielded 7.1 (range 1.6-25.1) deaths per 1000 people. The weighted median SMRs were 5.0 in males and 4.5 in females; relatively higher SMRs within studies were measured among children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMICs include those directly attributable to epilepsy, which yield a mean proportional mortality ratio (PMR) of 27.3% (range 5%-75.5%) derived from population-based studies. These direct causes comprise status epilepticus, with reported PMRs ranging from 5%-56.6%, and sudden unexpected death in epilepsy, with reported PMRs ranging from 1%-18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Significance Epilepsy in LMIC has a significantly greater premature mortality, as in high-income countries, but in LMIC the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AEDs.
- Subjects :
- Male
Pediatrics
medicine.medical_specialty
Adolescent
Premature mortality
Population
Poison control
Occupational safety and health
Article
Convulsions
Developing countries
03 medical and health sciences
Epilepsy
Death, Sudden
0302 clinical medicine
Sex Factors
Seizures
Risk Factors
Case fatality rate
Injury prevention
Medicine
Humans
Resource-poor countries
030212 general & internal medicine
education
Child
Case fatality
education.field_of_study
Surveillance, monitoring & evaluation
business.industry
Mortality, Premature
Mortality rate
Head injury
Age Factors
medicine.disease
Databases, Bibliographic
3. Good health
Death
Neurology
Socioeconomic Factors
Female
Neurology (clinical)
Medical emergency
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Epilepsia
- Accession number :
- edsair.doi.dedup.....6d3be3ed6bd9e0b79b4f7aa366f30081