U.S. Iraq and Afghanistan war veterans (IAVs) have a higher prevalence of mental and
physical comorbidity. IAVs with epilepsy were more
than twice as likely to die between 2011 and 2015 as were similar
veterans without epilepsy.
A study published in the U.S. Centers
for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report
revealed that IAVs have substantially higher mortality than
were veterans without epilepsy.
The study from investigators at The University of Texas Health Science Center at San Antonio,
the South Texas Veterans Health Care System, the CDC and several other
VA facilities examined records of more than 320,000 Iraq and Afghanistan
war veterans receiving VA care in 2010 and 2011, and found 2,187 who
met the criteria for epilepsy.
‘U.S. Iraq and Afghanistan war veterans with epilepsy were 2.6 times more likely to die during five-year span.’
Examination of mortality over the next
five years revealed that approximately five times more IAVs with
epilepsy died by the end of 2015 than similar IAVs without epilepsy.
Because IAVs with epilepsy were also significantly more likely to have
conditions such as cardiac disease, stroke, cancer and mental health
conditions that may also be associated with death, a second analysis
controlling for these co-occurring conditions was conducted to determine
if epilepsy uniquely contributed to mortality.
"Similar to studies of civilian samples, we found that cancer,
stroke and cardiac disease were strong predictors of five-year
mortality. But, even after controlling for the impact of these comorbid
conditions, we still found a substantial effect for epilepsy," said lead
author Mary Jo Pugh, professor of epidemiology,
biostatistics and medicine at the UT Health Science Center. "After
controlling for comorbidities, IAVs with epilepsy were about 2.6 times
more likely to die during the follow-up period than similar veterans
Causes of death were not available from federal databases at the
time the study was conducted, Dr. Pugh said. Therefore the report does
not speculate on cause of death such as suicidality, car accidents,
heart attack, cancer and sudden unexplained death in epilepsy.
The report makes it clear, however, that deaths and comorbidities
were more frequent in the highly vulnerable group of Iraq-Afghanistan
veterans with epilepsy. Epilepsy is a complex condition, and the
addition of these comorbidities presents health care providers with
competing demands, Dr. Pugh said.
"If you have a patient who comes in and is having seizures, that is
often the focus of care because persistent seizures can be life
threatening and have a substantial effect on quality of life," she said.
"But chronic disease management for other conditions is also needed. We
need to take a holistic approach in epilepsy care. We need to take care
of epilepsy and other conditions that affect patients' health, quality
of life and, ultimately, mortality."
This is the first published study to examine mortality in veterans
with epilepsy, and is unique compared to studies of epilepsy-related
mortality in the United States. Civilian studies in the United States
have consisted of small samples in localized areas, not a national
population such as the population of Iraq and Afghanistan war veterans,
Dr. Pugh said.
However, the growing availability of electronic health
records nationally makes this type of study in civilian settings more
feasible. Dr. Pugh is developing a plan to examine similar questions in
large data sets such as i2b2 locally, and eventually with data from the
Great Plains PCORnet Collaborative.