Objective:

To assess temporal patterns in epilepsy-related mortality among US individuals aged 0 to 19 years from 1999 through 2023, including differences by age, sex, and race and ethnicity.

Approach:

• Design and data: Cross-sectional analysis of CDC WONDER mortality data for deaths in which epilepsy or status epilepticus was the underlying cause.
• Analysis: Joinpoint regression estimated annual and average annual percentage changes in mortality trends by demographic group.

Key Findings:

• Epilepsy accounted for 4,472 deaths among US individuals aged 0 to 19 years during 1999–2023. The age-adjusted mortality rate rose from 0.2 per 100,000 in 1999 to 0.4 per 100,000 in 2023.
• Overall mortality was stable from 1999 to 2001, then increased by 5.6% annually through 2023.
• Mortality increased during later study periods among non-Hispanic White and non-Hispanic Black individuals, and increased consistently among males across the study period.
• Female mortality increased sharply from 2018 to 2023, by 15.7% annually.
• Mortality was generally stable among children aged 10 years or younger, but increased by 4.9% annually among children aged 2 years or younger after 2001. Among adolescents aged 11 to 19 years, mortality increased by 8.6% annually after 2008.

Interpretation:

The authors note that possible contributors to the observed trends include SUDEP, comorbidities, medication adherence, transitions between pediatric and adult care, and barriers to care access. The study does not establish the causes of the trends.

Limitations:

• Death certificates may underestimate epilepsy-related deaths when an external cause is recorded as the underlying cause.
• CDC WONDER lacks patient-level information, including data on comorbidities.
• The relatively low number of deaths among females may have increased variability in subgroup trend estimates.
• Low counts or suppressed estimates prevented reliable analysis of Hispanic, Asian or Pacific Islander, and American Indian or Alaska Native populations.

Conclusion:

The study found increasing epilepsy-related mortality in recent years overall and in several demographic groups, with less uniform trends among younger children. The authors call for further research into clinical, social, and structural determinants of mortality.

Sources:

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