| アブストラクト | OBJECTIVE: The incidence of late-onset epilepsy (LOE) is rising, and these patients may use an excess of health care resources. This study aimed to measure pre-/post-diagnostic health care use (HCU) for patients with LOE compared to controls. METHODS: This was an observational open cohort study covering years 1998-2019 using UK population-based linked primary care (Clinical Practice Research Datalink [CPRD]) and hospital (HES) electronic health records. The participants included patients with incident LOE enrolled in CPRD and 1:10 age-, sex-, and general practice-matched controls. The exposure was incident LOE (diagnosed at age >/=65) using a 5-year washout. The main outcome was all HCU (primary care [PC], accident and emergency [A&E], admitted patient and outpatient care) using inverse proportional weighting to PC use and HCU by setting. An interrupted time-series analysis was used to examine pre-/post-diagnostic HCU between patients with LOE and controls over 4 years either side of diagnosis/matching date. An adjusted mixed-effects negative binomial regression was used for post-diagnosis HCU interactions. RESULTS: Of 2 569 874 people >/=65 years of age, 1048 (4%) developed incident LOE. Mean weighted total HCU increased by 32 visits per patient-year (95% confidence interval [95% CI]: 13-50, p = .003) until LOE diagnosis, and then dropped by a mean of 60 visits per patient-year (95% CI: -81 to -40). There was an acute rise and fall over the 1-2 years immediately pre-/post-diagnosis. Incident HCU remained higher for LOE compared to controls post-diagnosis (adjusted incidence rate ratio: 1.72; 95% CI: 1.65-1.70; p < .001), including A&E, outpatient, and admitted care. SIGNIFICANCE: Health care use demonstrates an acute on chronic rise over the 4 years before diagnosis of LOE. To what extent the partial reversal of the acute pre-diagnosis rise, and the mediators of the accelerated increase compared to controls are attributed to epilepsy, comorbid and bidirectional disease states, or a combination of both warrants further exploration. |
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| 投稿者 | Berglund, Marta; Gonzalez-Izquierdo, Arturo; Denaxas, Spiros; Lethebe, B Cord; Sajobi, Tolulope T; Engbers, Jordan D T; Wiebe, Samuel; Josephson, Colin B |
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| 組織名 | UCL Institute of Health Informatics, London, UK.;Institute of Applied Health Research, University of Birmingham, Birmingham, UK.;Health Data Research (HDR) UK, London, UK.;Alan Turing Institute, London, UK.;Clinical Research Unit, Cumming School of Medicine, University of Calgary,;Calgary, Alberta, Canada.;Department of Clinical Neurosciences, Cumming School of Medicine, University of;Calgary, Calgary, Alberta, Canada.;Department of Community Health Sciences, Cumming School of Medicine, University;of Calgary, Calgary, Alberta, Canada.;Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.;O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta,;Canada.;Desid Labs Inc., Calgary, Alberta, Canada.;Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada. |
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