Association between social deprivation and incidence of first seizures and epilepsy: A prospective population‐based cohort

Abstract

Objective: Epidemiologic studies have investigated whether social deprivation is associated with a higher incidence of epilepsy, and results are conflicting, especially in children. The mechanisms underlying a potential association are unclear.This study examines whether there is an association between social deprivation and the incidence of first seizures (unprovoked and provoked) and new diagnosis of epilepsy by comparing incidence across an area-level measure of deprivation in a population-based cohort.Methods: Multiple methods of case identification followed by individual case validation and classification were carried out in a defined geographical area (population 542 868) to identify all incident cases of first provoked and first unprovoked seizures and new diagnosis of epilepsy presenting during the calendar year 2017. An area-level relative deprivation index, based on 10 indicators from census data, was assigned to each patient according to registered address and categorized into quintiles from most to least deprived. Results:The annual incidence of first unprovoked seizures (n = 372), first provoked seizures (n = 189), and new diagnosis of epilepsy (n = 336) was highest in the most deprived areas compared to the least deprived areas (incidence ratios of 1.79 [95% confidence interval (CI) = 1.26-2.52], 1.55 [95% CI = 1.04-2.32], and 1.83 [95% CI = 1.28-2.62], respectively). This finding was evident in both adults and children and in those with structural and unknown etiologies of epilepsy.

Impact of sociodemographic disadvantage on neurobehavioral outcomes in children with newly diagnosed seizures and their unaffected siblings over 36 months

“…It has been shown that disadvantage is a substantial factor of relevance in child and adult epilepsy and is linked to the incidence and prevalence of epilepsy. [42][43][44][45][46][47][48] We show evidence here that it also plays a role in neurobehavioral status. It is important to note, however, that these findings do not negate the finding that brain structural and connectivity factors as well as the underlying epilepsy disorder play a significant role in neurobehavioral status.…”

“…Our findings presented here extend our understanding of the impact and role of disadvantage in the epilepsy literature, which is consistent with health care outcome findings in multiple other disorders including asthma, autism, COVID-19, diabetes, and sleep health. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Examining the influence of disadvantage at the time of diagnosis as well as at 18 and 36 months later, we find that behavior problems, as rated by parents, the child's teacher, and the child with seizures him-/herself, all indicate that behavioral risk increases with greater social disadvantage. This unanimity of effect, across all informants, with the consistency of relationship over time, points to the robustness and reliability of the effect of disadvantage.…”

“…Based on past literature, each SD variable chosen is a relevant social determinant of health. [29][30][31][32][33][34][35][36][42][43][44][45][46][47][48] For caregiver education level and household income, those families below the mean for the sample were assigned a score of 1, whereas those families at or above the mean were assigned a score of 0. The distribution of income for this sample was nearly identical to national income statistics at the time of recruitment.…”

“…[34][35][36][37][38][39][40][41] In the field of epilepsy, there has been growing awareness of the impact of socioeconomic and neighborhood disadvantage on health and health-related factors in epilepsy. [42][43][44][45][46][47] In addition, SD may play a role in psychiatric outcomes of children with epilepsy, as children from poor families and from single-parent homes have a significantly higher risk of developing a psychiatric disorder compared to their less disadvantaged peers with epilepsy, 48 suggesting that lower socioeconomic status may be an independent factor associated with poor behavioral outcomes in youths with epilepsy. These findings, although insightful, do not compare the impact of disadvantage to the impact of traditional clinical epilepsy characteristics on neurobehavioral outcomes in this population.…”

Association of Neighborhood Deprivation With Cognitive and Mood Outcomes in Adults With Pharmacoresistant Temporal Lobe Epilepsy

“…Epilepsy is more prevalent among individuals in lower (more disadvantaged) socioeconomic groups, independent of social drift and other known epilepsy risk factors. [8][9][10] Furthermore, individuals with epilepsy are more likely to live in households with the lowest annual incomes. 11 By contrast, over the past decade, research on the social determinants of health has grown exponentially and suggests that social factors are a fundamental cause of health and disease.…”