Abstract：
OBJECTIVE: Research points to disparities in disease burden and access to medical care in epilepsy. We studied the association between socioeconomic status (SES) and antiseizure medication (ASM) use in pregnancies with maternal epilepsy.
METHODS: We conducted a cross-sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006-2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%-4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference.
RESULTS: Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03-1.57) to aRR = 1.66 for low education (95% CI: 1.30-2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88-2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29-2.24) and in polytherapy (aRR 2.65; 95% CI 1.66-4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08-1.26) to 1.26 (not married or cohabiting; 95% CI 1.17-1.36).
CONCLUSIONS: Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care.
METHODS: We conducted a cross-sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006-2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%-4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference.
RESULTS: Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03-1.57) to aRR = 1.66 for low education (95% CI: 1.30-2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88-2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29-2.24) and in polytherapy (aRR 2.65; 95% CI 1.66-4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08-1.26) to 1.26 (not married or cohabiting; 95% CI 1.17-1.36).
CONCLUSIONS: Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care.
摘要：
目的：研究指出了癫痫患者在疾病负担和获得医疗护理方面的差异。我们研究了孕妇癫痫患者的社会经济地位（SES）与抗癫痫药物（ASM）使用之间的关系。
方法：我们进行了一项横断面研究，包括2006-2017年期间从北欧注册中确定的21130例孕妇癫痫。SES指标包括同居状态，移民背景,教育程度,和家庭收入。主要结局是从怀孕前90天到出生的ASM使用的比例和模式。我们应用了多重插补来处理有2%-4%错误的SES变量。我们使用改良的Poisson回归以最高SES类别作为参考，估计了调整风险比（aRR）和95％置信区间（CIs）。
结果：受教育程度最高，收入最高的五分之一的母亲使用ASM的频率最低（56％和53％，分别)。我们观察到，在低SES的前三个月之前或期间，ASM停药的风险增加。风险估计取决于SES指标，从低收入的aRR=1.27（95％CI：1.03-1.57）到低教育的aRR=1.66（95％CI：1.30-2.13）。移民背景与妊娠早期开始ASM相关(aRR2.17;95%CI1.88-2.52)。在单药治疗（aRR1.70;95％CI1.29-2.24）和综合治疗（aRR2.65;95％CI1.66-4.21）中，低教育程度与妊娠期间使用丙戊酸钠相关。根据所使用的ASM，低教育程度还与从一种ASM转换到另一种ASM的风险增加37％至39％相关。对于其他SES指标，转换的RR变化从1.16(外国来源;95%CI1.08-1.26)到1.26(未结婚或同居;95%CI1.17-1.36)。
结论：低SES与风险较高的ASM使用模式有关：停药，迟到的开始，在怀孕期间转换。这些发现可能反映了意外怀孕，在获得先入为主的咨询方面存在差异，和次优护理。
方法：我们进行了一项横断面研究，包括2006-2017年期间从北欧注册中确定的21130例孕妇癫痫。SES指标包括同居状态，移民背景,教育程度,和家庭收入。主要结局是从怀孕前90天到出生的ASM使用的比例和模式。我们应用了多重插补来处理有2%-4%错误的SES变量。我们使用改良的Poisson回归以最高SES类别作为参考，估计了调整风险比（aRR）和95％置信区间（CIs）。
结果：受教育程度最高，收入最高的五分之一的母亲使用ASM的频率最低（56％和53％，分别)。我们观察到，在低SES的前三个月之前或期间，ASM停药的风险增加。风险估计取决于SES指标，从低收入的aRR=1.27（95％CI：1.03-1.57）到低教育的aRR=1.66（95％CI：1.30-2.13）。移民背景与妊娠早期开始ASM相关(aRR2.17;95%CI1.88-2.52)。在单药治疗（aRR1.70;95％CI1.29-2.24）和综合治疗（aRR2.65;95％CI1.66-4.21）中，低教育程度与妊娠期间使用丙戊酸钠相关。根据所使用的ASM，低教育程度还与从一种ASM转换到另一种ASM的风险增加37％至39％相关。对于其他SES指标，转换的RR变化从1.16(外国来源;95%CI1.08-1.26)到1.26(未结婚或同居;95%CI1.17-1.36)。
结论：低SES与风险较高的ASM使用模式有关：停药，迟到的开始，在怀孕期间转换。这些发现可能反映了意外怀孕，在获得先入为主的咨询方面存在差异，和次优护理。
