Gorton HC, et al. - Using the Clinical Practice Research Datalink (CPRD) in England and the Secure Anonymised Information Linkage (SAIL) Databank in Wales, researchers attempted to evaluate the cause-specific unnatural mortality risks in people with epilepsy, as well as intended to determine the medication types involved in poisoning deaths. Individuals with epilepsy were discovered to be at a greater risk of unnatural death compared to people without epilepsy and therefore required adequate advice regarding unintentional injury prevention and monitoring for suicidal ideation, thoughts, and behaviors. Data recommended the consideration of suitability and toxicity of concomitant medication while prescribing for comorbid conditions.

Methods

• Data was extracted from 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014).
• During this trial, each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy.
• Experts assessed the unnatural mortality through International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records.
• An estimation was conducted of the hazard ratios (HRs) in each data set via a stratified Cox proportional hazards model, and meta-analyses were carried out using DerSimonian and Laird random-effects models.
• It was carried out from January 5, 2016, to November 16, 2017.
• People with epilepsy were detected with the aid of primary care epilepsy diagnoses and associated antiepileptic drug prescriptions.
• The primary outcome included hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths.

Results

• This study included 44,678 individuals in the CPRD and 14,051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891,429 (CPRD) and 279,365 (SAIL) individuals in the comparison cohorts.
• It was determined that 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts.
• Data unveiled that subjects with epilepsy exhibited a notably greater likelihood of death due to any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) vs people in the comparison cohort.
• As per the results, large risk increases were noted in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53).
• Findings revealed that opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] exhibited a more frequently involvement than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy.