Disparities in injury death location for people with epilepsy/seizures.
ABSTRACT Wide variation has been reported in the proportion of injury deaths occurring during the prehospital phase. Potential disparities in where injured people with epilepsy and seizure disorders die have not been examined. We compared location of death between injured patients with epilepsy and seizure disorders and similar patients without epilepsy/seizures and tested the hypothesis that injured people with epilepsy/seizures are more likely to die outside of a hospital or health care setting.
U.S. vital statistics (mortality) data from the multiple cause of death files of the National Center for Health Statistics were analyzed. Patients less than 65 years of age at death who had injury as the underlying cause of death were included. Multinomial logistic regression was used to assess location of death, controlling for patient and injury characteristics.
Controlling for potential confounders, people with epilepsy/seizures were more likely to die at home from unintentional injuries (relative risk ratio [RRR]=1.51, P<0.001) and less likely to die in public places (RRR=0.27, P<0.001). People with epilepsy/seizures were less likely to die at home or in public places from suicide, but significantly more likely to die at home from homicide (RRR=2.29, P<0.001). By mechanism of injury, people with epilepsy/seizures were more likely to die at home from drowning (RRR=2.35, P<0.001).
Disparities in where injured people with epilepsy/seizures die deserve further attention. Identifying the underlying causes of these disparities will allow for the development of targeted prevention interventions.
SourceAvailable from: Birgitte Wulff[Show abstract] [Hide abstract]
ABSTRACT: Obesity is a major burden to people and to the health care systems around the world. This study aims at characterizing the effect of a novel selective alpha-MSH (α-MSH) analogue on obesity and insulin sensitivity. The sub-chronic effects of the selective MC4-R peptide agonist MC4-NN1-0182 was investigated in diet induced obese (DIO) rats and DIO minipigs by assessing the effects on food intake, energy consumption, and body weight. Acute effect of MC4-NN1-0182 on insulin sensitivity was assessed by a euglycemic-hyperinsulinemic clamp study in normal rats. Three weeks treatment of DIO rats with MC4-NN1-0182 caused a decrease in food intake and a significant decrease in body weight 7 ± 1%, p < 0.05 compared to 3 ± 1% increase in the vehicle control. In DIO minipigs, eight weeks of treatment with MC4-NN1-0182 resulted in a body weight loss of 13.3 ± 2.5 kg (13 ± 3 %), whereas the vehicle control group had gained 3.7 ± 1.4 kg (4 ± 1 %). Finally, clamp studies in normal rats showed that acute treatment with MC4-NN1-0182 caused a significant increase in glucose disposal (Rd) compared to vehicle control (Rd, mg/kg/min, 17.0 ± 0.7 vs. 13.9 ± 0.6 , p < 0.01). We demonstrate that treatment of DIO rats or minipigs with a selective MC4-R peptide agonist causes weight loss. Moreover, we have demonstrated weight independent effects on insulin sensitivity. Our observations identify MC4 agonism as a viable target for the treatment of obesity and insulin resistance.Journal of Endocrinology 11/2013; 220(2). DOI:10.1530/JOE-13-0284 · 3.59 Impact Factor
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ABSTRACT: Purpose To examine trends in reporting injury as a cause of death among people with epilepsy in the U.S. during the past three decades. Methods We analyzed the U.S. multiple causes of death data from death certificates in 1981–2010 to compare rate and odds ratios (OR) of reporting injury as cause of death among cases with vs. without mention of epilepsy across years. Results The trends in reporting epilepsy with and without injury were similar in most age groups but were inconsistent in most external causes of injury. The OR of reporting injury was 1.02 (95% CI 0.97-1.07) in 1981-85 and decreased to 0.52 (95% CI 0.48-0.55) in 2006-10. The decline in OR was prominent among people aged 15-24 followed by people aged 25-44. For the five external causes of injury, the OR of suffocation and drowning were 6.32 (95% CI 5.91-6.75) and 5.64 (95% CI 5.16-6.16) in 1981-85 and decreased to 3.03 (95% CI 2.74-3.35) and 2.56 (95% CI 2.18-3.00) in 2006-10. The OR for poisoning and traffic crashes were 0.70 (95% CI 0.57-0.85) and 0.08 (95% CI 0.07-0.09) in 1981-1985 and 0.21 (95% CI 0.18-0.25) and 0.06 (95% CI 0.05-0.08) in 2006-10. Conclusions The risk of fatal injury among people with epilepsy decreased drastically during the past three decades in most age groups and for most external causes of injury except falls. People with epilepsy had lower risks of dying from injury due to poisoning or traffic crashes, had higher risks of dying from suffocation and drowning.Seizure 11/2014; DOI:10.1016/j.seizure.2014.07.002 · 2.06 Impact Factor
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ABSTRACT: Objective To examine mortality and causes of death (CODs) in socioeconomically disadvantaged persons with epilepsy (PWEs) in the United States.Methods We performed a retrospective open cohort analysis using Ohio Medicaid claims data between 1992 and 2008 to assess mortality and COD in 68,785 adult Medicaid beneficiaries with epilepsy. Case fatality (CF), mortality rates (MRs), standardized mortality ratios (SMRs), and years of potential life lost (YPLLs) were calculated. The SMRs were estimated to compare risk of death in PWEs with that in the general Medicaid population with and without disabilities. Proportionate mortality ratios (PMRs), YPLLs, and SMRs for specific COD were also obtained.ResultsThere were 12,630 deaths in PWEs. CF was 18.4%, the age-race-sex adjusted MR was 18.6/1,000 person-years (95% confidence interval [CI], 18.3–18.9). The SMR was 1.8 (95% CI, 1.8–1.9) when compared to the general Medicaid population, and was 1.4 (95% CI, 1.3–1.6) when compared to those with disabilities. The average YPLL was 16.9 years (range 1–47 years). Both epilepsy and comorbid conditions significantly contributed to premature mortality in PWEs. Cardiovascular diseases, cancer, and unintentional injuries were the most common COD and account for a large proportion of YPLLs. Deaths from epilepsy-related causes occurred in about 10% of the cases.SignificanceSocioeconomically deprived PWEs, especially young adults, experience high mortality and die 17 years prematurely. The high mortality in Medicaid beneficiaries with epilepsy affirms that comorbid conditions and epilepsy play a crucial role in premature death. Management of comorbid conditions is, at a minimum, as important as epilepsy management, and therefore deserves more attention from physicians, particularly those who care for Medicaid beneficiaries with epilepsy.Epilepsia 09/2014; DOI:10.1111/epi.12789 · 4.58 Impact Factor