Alcohol-Specific Mortality in People With Epilepsy:   Cohort Studies in Two Independent Population-Based Datasets

Hayley C. Gorton; Roger T. Webb; Rosa Parisi; Matthew J. Carr; Marcos DelPozo-Banos; Kieran J. Moriarty; W. Owen Pickrell; Ann John; Darren M. Ashcroft

doi:10.3389/fneur.2020.623139

Alcohol-Specific Mortality in People With Epilepsy: Cohort Studies in Two Independent Population-Based Datasets

Hayley C. Gorton, Roger T. Webb, Rosa Parisi, Matthew J. Carr, Marcos DelPozo-Banos, Kieran J. Moriarty, W. Owen Pickrell, Ann John, Darren M. Ashcroft

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: The risk of dying by alcohol-specific causes in people with epilepsy has seldom been reported from population-based studies. We aimed to estimate the relative risk of alcohol-specific mortality in people with epilepsy, and the extent to which problematic alcohol use was previously identified in the patients' medical records.Method: We delineated cohort studies in two population-based datasets, the Clinical Practice Research Datalink (CPRD GOLD) in England (January 01, 2001–December 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (January 01, 2001–December 31, 2014), linked to hospitalization and mortality records. People with epilepsy were matched to up to 20 persons without epilepsy on gender, age (±2 years) and registered general practice. We identified alcohol-specific death from Office for National Statistics (ONS) records using specified ICD-10 codes. We further identified prescriptions, interventions and hospitalisations related to alcohol use.Results: In the CPRD GOLD, we identified 9,871 individuals in the incident epilepsy cohort and 185,800 in the comparison cohort and, in the SAIL Databank, these numbers were 5,569 and 110,021, respectively. We identified a five-fold increased risk of alcohol-specific mortality in people with epilepsy vs. those without the condition in our pooled estimate across the two datasets (deprivation-adjusted HR 4.85, 95%CI 3.46–6.79).Conclusions: People with epilepsy are at increased risk of dying by an alcohol-specific cause than those without the disorder. It is plausible that serious alcohol misuse could either contribute to the development of epilepsy or it could commence subsequent to epilepsy being diagnosed. Regardless of the direction of the association, it is important that the risk of dying as a consequence of alcohol misuse is accurately quantified in people affected by epilepsy. Systematically-applied, sensitive assessment of alcohol consumption by healthcare professionals, at opportunistic, clinical contacts, with rapid access to quality treatment services, should be mandatory and play a key role in reduction of health harms and mortality.

Original language	English
Article number	623139
Number of pages	7
Journal	Frontiers in Neurology
Volume	11
DOIs	https://doi.org/10.3389/fneur.2020.623139
Publication status	Published - 21 Jan 2021

Bibliographical note

Funding Information: This study is partly based on data from the Clinical Practice Research Datalink obtained under license from the MHRA. The data are provided by patients and collected by the NHS as part of their care and support. This study also used anonymized data held in the SAIL system, which is part of the national e-health records infrastructure for Wales. The Office for National Statistics (ONS) is the provider of the ONS mortality data. HES and ONS data is subject to Crown copyright (2015) protection, re-used with the permission of The Health & Social Care Information Center, all rights reserved. The interpretation and conclusions contained in this study are those of the authors alone, and not necessarily those of the SAIL, UK Medicines and Healthcare Products Regulatory Agency (MHRA), the National Institute for Health Research (NIHR), National Health Service (NHS), or the Department of Health. We acknowledge the contributing patients and practices to the CPRD GOLD and SAIL Databank who have allowed their data to be used for research purposes. Funding. This work was funded by the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care (Grant number: PSTRC-2016-003). Publisher Copyright: © Copyright © 2021 Gorton, Webb, Parisi, Carr, DelPozo-Banos, Moriarty, Pickrell, John and Ashcroft. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

M1 - 623139

Keywords

Epilepsy
Alcohol
Alcohol-specific
Cohort
Observational
alcohol
alcohol-specific
epilepsy
observational
cohort

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10.3389/fneur.2020.623139

http://www.scopus.com/inward/record.url?scp=85100527845&partnerID=8YFLogxK

Cite this

@article{56c7a1ba7f214de5a00b521071d1b384,

title = "Alcohol-Specific Mortality in People With Epilepsy: Cohort Studies in Two Independent Population-Based Datasets",

abstract = "Objectives: The risk of dying by alcohol-specific causes in people with epilepsy has seldom been reported from population-based studies. We aimed to estimate the relative risk of alcohol-specific mortality in people with epilepsy, and the extent to which problematic alcohol use was previously identified in the patients' medical records.Method: We delineated cohort studies in two population-based datasets, the Clinical Practice Research Datalink (CPRD GOLD) in England (January 01, 2001–December 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (January 01, 2001–December 31, 2014), linked to hospitalization and mortality records. People with epilepsy were matched to up to 20 persons without epilepsy on gender, age (±2 years) and registered general practice. We identified alcohol-specific death from Office for National Statistics (ONS) records using specified ICD-10 codes. We further identified prescriptions, interventions and hospitalisations related to alcohol use.Results: In the CPRD GOLD, we identified 9,871 individuals in the incident epilepsy cohort and 185,800 in the comparison cohort and, in the SAIL Databank, these numbers were 5,569 and 110,021, respectively. We identified a five-fold increased risk of alcohol-specific mortality in people with epilepsy vs. those without the condition in our pooled estimate across the two datasets (deprivation-adjusted HR 4.85, 95%CI 3.46–6.79).Conclusions: People with epilepsy are at increased risk of dying by an alcohol-specific cause than those without the disorder. It is plausible that serious alcohol misuse could either contribute to the development of epilepsy or it could commence subsequent to epilepsy being diagnosed. Regardless of the direction of the association, it is important that the risk of dying as a consequence of alcohol misuse is accurately quantified in people affected by epilepsy. Systematically-applied, sensitive assessment of alcohol consumption by healthcare professionals, at opportunistic, clinical contacts, with rapid access to quality treatment services, should be mandatory and play a key role in reduction of health harms and mortality.",

keywords = "Epilepsy, Alcohol, Alcohol-specific, Cohort, Observational, alcohol, alcohol-specific, epilepsy, observational, cohort",

author = "Gorton, {Hayley C.} and Webb, {Roger T.} and Rosa Parisi and Carr, {Matthew J.} and Marcos DelPozo-Banos and Moriarty, {Kieran J.} and Pickrell, {W. Owen} and Ann John and Ashcroft, {Darren M.}",

note = "Funding Information: This study is partly based on data from the Clinical Practice Research Datalink obtained under license from the MHRA. The data are provided by patients and collected by the NHS as part of their care and support. This study also used anonymized data held in the SAIL system, which is part of the national e-health records infrastructure for Wales. The Office for National Statistics (ONS) is the provider of the ONS mortality data. HES and ONS data is subject to Crown copyright (2015) protection, re-used with the permission of The Health & Social Care Information Center, all rights reserved. The interpretation and conclusions contained in this study are those of the authors alone, and not necessarily those of the SAIL, UK Medicines and Healthcare Products Regulatory Agency (MHRA), the National Institute for Health Research (NIHR), National Health Service (NHS), or the Department of Health. We acknowledge the contributing patients and practices to the CPRD GOLD and SAIL Databank who have allowed their data to be used for research purposes. Funding. This work was funded by the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care (Grant number: PSTRC-2016-003). Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2021 Gorton, Webb, Parisi, Carr, DelPozo-Banos, Moriarty, Pickrell, John and Ashcroft. Copyright: Copyright 2021 Elsevier B.V., All rights reserved. M1 - 623139",

year = "2021",

month = jan,

day = "21",

doi = "10.3389/fneur.2020.623139",

language = "English",

volume = "11",

journal = "Frontiers in Neurology",

issn = "1664-2295",

publisher = "Frontiers Media S.A.",

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TY - JOUR

T1 - Alcohol-Specific Mortality in People With Epilepsy

T2 - Cohort Studies in Two Independent Population-Based Datasets

AU - Gorton, Hayley C.

AU - Webb, Roger T.

AU - Parisi, Rosa

AU - Carr, Matthew J.

AU - DelPozo-Banos, Marcos

AU - Moriarty, Kieran J.

AU - Pickrell, W. Owen

AU - John, Ann

AU - Ashcroft, Darren M.

N1 - Funding Information: This study is partly based on data from the Clinical Practice Research Datalink obtained under license from the MHRA. The data are provided by patients and collected by the NHS as part of their care and support. This study also used anonymized data held in the SAIL system, which is part of the national e-health records infrastructure for Wales. The Office for National Statistics (ONS) is the provider of the ONS mortality data. HES and ONS data is subject to Crown copyright (2015) protection, re-used with the permission of The Health & Social Care Information Center, all rights reserved. The interpretation and conclusions contained in this study are those of the authors alone, and not necessarily those of the SAIL, UK Medicines and Healthcare Products Regulatory Agency (MHRA), the National Institute for Health Research (NIHR), National Health Service (NHS), or the Department of Health. We acknowledge the contributing patients and practices to the CPRD GOLD and SAIL Databank who have allowed their data to be used for research purposes. Funding. This work was funded by the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care (Grant number: PSTRC-2016-003). Publisher Copyright: © Copyright © 2021 Gorton, Webb, Parisi, Carr, DelPozo-Banos, Moriarty, Pickrell, John and Ashcroft. Copyright: Copyright 2021 Elsevier B.V., All rights reserved. M1 - 623139

PY - 2021/1/21

Y1 - 2021/1/21

N2 - Objectives: The risk of dying by alcohol-specific causes in people with epilepsy has seldom been reported from population-based studies. We aimed to estimate the relative risk of alcohol-specific mortality in people with epilepsy, and the extent to which problematic alcohol use was previously identified in the patients' medical records.Method: We delineated cohort studies in two population-based datasets, the Clinical Practice Research Datalink (CPRD GOLD) in England (January 01, 2001–December 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (January 01, 2001–December 31, 2014), linked to hospitalization and mortality records. People with epilepsy were matched to up to 20 persons without epilepsy on gender, age (±2 years) and registered general practice. We identified alcohol-specific death from Office for National Statistics (ONS) records using specified ICD-10 codes. We further identified prescriptions, interventions and hospitalisations related to alcohol use.Results: In the CPRD GOLD, we identified 9,871 individuals in the incident epilepsy cohort and 185,800 in the comparison cohort and, in the SAIL Databank, these numbers were 5,569 and 110,021, respectively. We identified a five-fold increased risk of alcohol-specific mortality in people with epilepsy vs. those without the condition in our pooled estimate across the two datasets (deprivation-adjusted HR 4.85, 95%CI 3.46–6.79).Conclusions: People with epilepsy are at increased risk of dying by an alcohol-specific cause than those without the disorder. It is plausible that serious alcohol misuse could either contribute to the development of epilepsy or it could commence subsequent to epilepsy being diagnosed. Regardless of the direction of the association, it is important that the risk of dying as a consequence of alcohol misuse is accurately quantified in people affected by epilepsy. Systematically-applied, sensitive assessment of alcohol consumption by healthcare professionals, at opportunistic, clinical contacts, with rapid access to quality treatment services, should be mandatory and play a key role in reduction of health harms and mortality.

AB - Objectives: The risk of dying by alcohol-specific causes in people with epilepsy has seldom been reported from population-based studies. We aimed to estimate the relative risk of alcohol-specific mortality in people with epilepsy, and the extent to which problematic alcohol use was previously identified in the patients' medical records.Method: We delineated cohort studies in two population-based datasets, the Clinical Practice Research Datalink (CPRD GOLD) in England (January 01, 2001–December 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (January 01, 2001–December 31, 2014), linked to hospitalization and mortality records. People with epilepsy were matched to up to 20 persons without epilepsy on gender, age (±2 years) and registered general practice. We identified alcohol-specific death from Office for National Statistics (ONS) records using specified ICD-10 codes. We further identified prescriptions, interventions and hospitalisations related to alcohol use.Results: In the CPRD GOLD, we identified 9,871 individuals in the incident epilepsy cohort and 185,800 in the comparison cohort and, in the SAIL Databank, these numbers were 5,569 and 110,021, respectively. We identified a five-fold increased risk of alcohol-specific mortality in people with epilepsy vs. those without the condition in our pooled estimate across the two datasets (deprivation-adjusted HR 4.85, 95%CI 3.46–6.79).Conclusions: People with epilepsy are at increased risk of dying by an alcohol-specific cause than those without the disorder. It is plausible that serious alcohol misuse could either contribute to the development of epilepsy or it could commence subsequent to epilepsy being diagnosed. Regardless of the direction of the association, it is important that the risk of dying as a consequence of alcohol misuse is accurately quantified in people affected by epilepsy. Systematically-applied, sensitive assessment of alcohol consumption by healthcare professionals, at opportunistic, clinical contacts, with rapid access to quality treatment services, should be mandatory and play a key role in reduction of health harms and mortality.

KW - Epilepsy

KW - Alcohol

KW - Alcohol-specific

KW - Cohort

KW - Observational

KW - alcohol

KW - alcohol-specific

KW - epilepsy

KW - observational

KW - cohort

U2 - 10.3389/fneur.2020.623139

DO - 10.3389/fneur.2020.623139

M3 - Article

SN - 1664-2295

VL - 11

JO - Frontiers in Neurology

JF - Frontiers in Neurology

M1 - 623139

ER -