Abstract：
BACKGROUND: Socioeconomic inequalities in epilepsy incidence and its adverse outcomes are documented internationally, yet the extent of inequalities and factors influencing the association can differ between countries. A UK public health response to epilepsy, which prevents epilepsy without widening inequalities, is required. However, the data on UK epilepsy inequalities have not been synthesised in a review and the underlying determinants are unknown.
METHODS: In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143).
RESULTS: We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16-1·56]; I2=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I2=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19-1·57]; I2=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes.
CONCLUSIONS: Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes.
BACKGROUND: Epilepsy Research Institute UK.
METHODS: In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143).
RESULTS: We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16-1·56]; I2=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I2=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19-1·57]; I2=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes.
CONCLUSIONS: Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes.
BACKGROUND: Epilepsy Research Institute UK.
摘要：
背景：癫痫发病率及其不良后果的社会经济不平等在国际上有记载，然而，各国之间的不平等程度和影响协会的因素可能有所不同。英国对癫痫的公共卫生反应，在不扩大不平等的情况下预防癫痫，是必需的。然而,关于英国癫痫不平等的数据尚未在综述中综合,潜在的决定因素未知.
方法：在本系统综述和荟萃分析中，我们搜索了六个书目数据库(MEDLINE，Embase,PsycINFO,CINAHL,WebofScience,和Scopus）和1980年1月1日至2024年2月21日之间发表的灰色文献，以根据社会经济因素（个体水平或地区水平）确定英国报告癫痫发病率或癫痫相关不良结局的研究。我们纳入了纵向队列研究，使用常规收集的医疗保健数据的研究，横断面研究，以及匹配的队列研究和排除的会议摘要，以及在审查和荟萃分析中未报告实证结果的研究。多个审阅者(KJB,EC,SER,WOP,和RHT)独立筛选的研究，KJB从所包含的研究中提取数据，并由第二审阅者（SM或EC）检查数据提取。我们使用关键评估技能计划检查表来评估质量。我们使用随机效应荟萃分析来汇总事件发生率比率（IRRs），并对不良结果进行了叙述。本研究在PROPSPERO(CRD42023394143)上注册。
结果：我们从数据库搜索中确定了2471项独特的研究。我们纳入了26项研究，根据社会经济因素,其中10例报告了癫痫的发病率,16例报告了癫痫相关的不良结局.错误分类,参与,和解释性偏差被确定为研究质量限制。荟萃分析显示，社会经济剥夺与癫痫发病率之间存在关联，与低剥夺组相比,高剥夺组(IRR1·34[95%CI1·16-1·56];I2=85%)和中剥夺组(IRR1·23[95%CI1·08-1·39];I2=63%)发生癫痫的风险更高.这种关联在仅包括儿童的研究中仍然存在（高与低：IRR1·36[95％CI1·19-1·57]；I2=0％）。只有两项研究检查了影响癫痫发病率的因素。关于英国不利结果不平等的证据有限。
结论：在英国，癫痫发病率的社会经济不平等是显而易见的。制定以证据为基础的癫痫公共卫生应对措施，需要进一步的研究来了解受影响的人群，决定关联的因素，以及不利结果不平等的程度。
背景：英国癫痫研究所。
方法：在本系统综述和荟萃分析中，我们搜索了六个书目数据库(MEDLINE，Embase,PsycINFO,CINAHL,WebofScience,和Scopus）和1980年1月1日至2024年2月21日之间发表的灰色文献，以根据社会经济因素（个体水平或地区水平）确定英国报告癫痫发病率或癫痫相关不良结局的研究。我们纳入了纵向队列研究，使用常规收集的医疗保健数据的研究，横断面研究，以及匹配的队列研究和排除的会议摘要，以及在审查和荟萃分析中未报告实证结果的研究。多个审阅者(KJB,EC,SER,WOP,和RHT)独立筛选的研究，KJB从所包含的研究中提取数据，并由第二审阅者（SM或EC）检查数据提取。我们使用关键评估技能计划检查表来评估质量。我们使用随机效应荟萃分析来汇总事件发生率比率（IRRs），并对不良结果进行了叙述。本研究在PROPSPERO(CRD42023394143)上注册。
结果：我们从数据库搜索中确定了2471项独特的研究。我们纳入了26项研究，根据社会经济因素,其中10例报告了癫痫的发病率,16例报告了癫痫相关的不良结局.错误分类,参与,和解释性偏差被确定为研究质量限制。荟萃分析显示，社会经济剥夺与癫痫发病率之间存在关联，与低剥夺组相比,高剥夺组(IRR1·34[95%CI1·16-1·56];I2=85%)和中剥夺组(IRR1·23[95%CI1·08-1·39];I2=63%)发生癫痫的风险更高.这种关联在仅包括儿童的研究中仍然存在（高与低：IRR1·36[95％CI1·19-1·57]；I2=0％）。只有两项研究检查了影响癫痫发病率的因素。关于英国不利结果不平等的证据有限。
结论：在英国，癫痫发病率的社会经济不平等是显而易见的。制定以证据为基础的癫痫公共卫生应对措施，需要进一步的研究来了解受影响的人群，决定关联的因素，以及不利结果不平等的程度。
背景：英国癫痫研究所。
