How often do people with epilepsy die due to alcohol-specific causes and are there missed opportunities for support?

Problem

The International League Against Epilepsy “Call for action” states the need for accurate estimation of cause-specific mortality in people with epilepsy. This includes the specific contribution of alcohol, which is currently poorly captured. We therefore aimed to estimate the risk of alcohol-specific death in people with epilepsy compared to those without, and to determine treatment and care in primary care related to alcoholism, and associated hospital admissions.

Approach

We delineated a cohort of people with incident epilepsy between 01/01/1990-31/03/2014, and aged 18 or over from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. We matched each person in this cohort to up to twenty people without epilepsy on gender, year of birth (+/- 2 years) and general practice. We applied the ONS definition of alcohol-specific death using ICD-10 codes to identify alcohol-specific death. We estimated the hazard ratio for alcohol-specific death using stratified-Cox proportional hazards models adjusted for area-level deprivation. We estimated the proportion previously treated for alcohol problems in primary care and those admitted to hospital for their alcohol problems.

Findings

There were 9,871 people in the incident epilepsy cohort and 185,800 people in the matched cohort. Twenty-nine people with epilepsy died due to alcohol-specific causes, compared to 106 in the matched cohort. This corresponds to a deprivation-adjusted hazard ratio of 5.43 (95%CI 3.80-7.75). Amongst those who died due to alcohol-specific causes, the following proportions were observed in the epilepsy and comparison cohorts respectively: treated for alcohol dependence (24.1% vs. 9.4%); received support in primary care (20.7% vs 11.3%) and hospitalised for alcohol-related illness (51.7% vs. 38.7%).

Consequences

People with epilepsy are five-times more likely to die due to alcohol-specific causes compared to those without the condition. Not all of these individuals had a record of care related to alcohol. This presents a missed opportunity in the care of people with epilepsy in primary care; particularly in primary care where the proportion of individuals cared for regarding alcoholism was low.