背景:过早死亡是癫痫负担的重要组成部分,可能因人群而异,特别是在高收入国家和中低收入国家之间。中国的癫痫患者约占全球癫痫人口的五分之一。由于设计上的限制,以前的研究不太可能代表中国的情况,方法,样本量,随访时间,和其他固有的种群异质性。
结论:通过总结过去六十年中国癫痫患者死亡率特征的证据,在基于人群的研究中,我们发现中位死亡率为14.7(6.8-74.4)/1000人年,中位标准化死亡率(SMR)为4.4(2.6-12.9),在基于医院的研究中,中位死亡率为12.3(9.5-101.5)/1000人年,中位SMR为3.0(1.5-5.1).血管疾病,糖尿病并发症,意外伤害是死亡的主要原因。死亡的危险因素报告为年龄较大,男性,持续时间更长,癫痫发作频率更高。成人癫痫持续状态(SE)的病死率高于儿童,且均随随访时间增加。有症状的癫痫患者的死亡率很高,并且在不同的原发性疾病中有所不同。
结论:据报道,中国最不发达地区的癫痫死亡率和猝死发生率最高。意外伤害是癫痫相关死亡的最常见原因,而SUDEP在中国人群中的发病率可能被低估。有必要进行进一步的研究,以提高对过早死亡风险的理解,以便采取预防措施来改善这种情况。
BACKGROUND: Premature mortality is a significant part of the epilepsy burden and may vary across populations, especially between high-income and lower- and middle-income countries. People with epilepsy in China are approximately a fifth of the global population with epilepsy. Previous studies were unlikely to represent the situation in China due to limitations in design, methods, sample size, follow-up time, and other inherent population heterogeneity.
CONCLUSIONS: By summarising the evidence on the mortality characteristics in Chinese populations with epilepsy in the last 6 decades, we found a median mortality rate of 14.7 (6.8-74.4)/1,000 person-years and a median standardised mortality ratio (SMR) of 4.4 (2.6-12.9) in population-based studies, and a median mortality rate of 12.3 (9.5-101.5)/1,000 person-years and a median SMR of 3.0 (1.5-5.1) in hospital-based studies. Vascular diseases, complications of diabetes, and accidental injuries were the leading causes of death. Risk factors for mortality were reported as older age, male, longer duration, and higher frequency of seizures. Case fatality ratios of status epilepticus in adults were higher than in children, and both increased with follow-up time. Mortality in people with symptomatic epilepsy was high and varied across different primary diseases.
CONCLUSIONS: The highest mortality rate and sudden unexpected death in epilepsy (SUDEP) incidence were reported from the least developed areas in China. Accidental injuries were the most common causes of epilepsy-related deaths, while the incidence of SUDEP may be underestimated in Chinese populations. Further research is warranted to improve the understanding of premature mortality risk so that preventative measures can be introduced to improve the situation.