The epidemiology of status epilepticus in the United States.

OBJECTIVE: To summarize trends in status epilepticus (SE) in the United States by age, race, sex, admission source, disposition, incidence rates, and mortality. METHODS: Data from US National Hospital Discharge Survey were used from 1979 to 2010 to identify discharges with SE and common etiologies and complications of SE using International Classification of Diseases, 9th Revision, Clinical Modifications codes. Temporal trends in the incidence and in-hospital mortality of SE were examined with respect to age, sex, and race. RESULTS: We identified 760,117 discharges with SE over 32 years. The incidence of SE increased from 3.5 to 12.5/100,000 between 1979 and 2010, without a significant change in in-hospital mortality. Higher incidence, earlier age of onset, and higher mortality were observed among males. Age stratification revealed a "U-shaped" distribution with higher incidence at age <10 years (14.3/100,000) and age >50 years (approaching 28.4/100,000). In-hospital mortality, however, was the lowest (2.6 %) at age <10 years and approached 20.2 % with age ≥80 years. The incidence of SE was higher among blacks (13.7/100,000), compared to whites (6.9/100,000) and other races (7.4/100,000). Mortality, however, was lower among blacks (7.2 %) compared to whites and other races (9.8 and 9.2 %, respectively). Black men had the highest incidence (15.0/100,000), relatively younger age of onset (39.3 years) and the lowest mortality (5.6 %). A net temporal decline in the reported prevalence of epilepsy, central nervous system infections, and traumatic brain injury was noted among SE cohort. CONCLUSIONS: The incidence of SE increased nearly fourfold with relatively unchanged mortality. Gender and racial disparities exist in the incidence of SE, and age is an important predictor of mortality.

Socioeconomic deprivation independent of ethnicity increases status epilepticus risk.

BACKGROUND: A higher incidence of convulsive status epilepticus (CSE) has been reported in nonwhite compared to white populations. Socioeconomic factors can be intricately involved in observed ethnic "effects," and the importance of socioeconomic status on health conditions is widely recognized. Understanding the effect of socioeconomic factors on CSE would provide insights into etiology and management, leading to the development of novel prevention strategies. METHODS: From a population-based UK study on childhood CSE, we tested the hypothesis that socioeconomic deprivation independent of ethnicity increases the risk of childhood CSE. Home postal codes were used to measure the socioeconomic status of the neighborhood in which patients lived relative to that of the borough in which the neighborhood was located. The child's ethnicity was reported by parent(s). Relationships between socioeconomic status, ethnicity, and incidence were investigated using Poisson regression analysis. RESULTS: A total of 176 children were enrolled. The incidence of CSE in nonwhite children [18.5, 95% confidence interval (CI) 13.7-23.3/100,000/year] was 1.8 (95% CI 1.3-2.4) times greater than for white children (10.5, 95% CI 7.9-13.1/100,000/year) (p < 0.0005). Socioeconomic deprivation and Asian ethnicity were independently associated with increased incidence. For each point increase in Index of Multiple Deprivation (IMD) 2004, there was a 1.03 cumulative increased relative risk (95% CI 1.01-1.06, p = 0.007). Asian children were 5.7 times (95% CI 1.7-18.9) more likely than white children to have a first-ever episode of CSE (p = 0.004). Socioeconomic and ethnicity effects were related to etiology of CSE. INTERPRETATION: Ethnic and socioeconomic factors independently affect risk for prolonged febrile seizures and acute symptomatic CSE, but not for other types of childhood CSE.