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Lookup NU author(s): Kathryn BushORCiD, Dr Emer Cullen, Dr Susanna Mills, Dr Rhys ThomasORCiD, Dr Andrew KingstonORCiD, Professor Sheena Ramsay
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Socioeconomic inequalities in epilepsy incidence and its adverse outcomes are documented internationally, yet the extent of inequalities and factors influencing the association can differ between countries. A UK public health response to epilepsy, which prevents epilepsy without widening inequalities, is required. However, the data on UK epilepsy inequalities have not been synthesised in a review and the underlying determinants are unknown. Methods: In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143). Findings: We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16–1·56]; I2=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08–1·39]; I2=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19–1·57]; I2=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes. Interpretation: Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes. Funding: Epilepsy Research Institute UK.
Author(s): Bush KJ, Cullen E, Mills S, Chin RFM, Thomas RH, Kingston A, Pickrell WO, Ramsay SE
Publication type: Article
Publication status: Published
Journal: The Lancet Public Health
Year: 2024
Volume: 9
Issue: 8
Pages: e614-e628
Print publication date: 01/08/2024
Acceptance date: 02/04/2018
Date deposited: 13/08/2024
ISSN (electronic): 2468-2667
Publisher: Elsevier Ltd
URL: .10.1016/S2468-2667(24)00132-4
DOI: 10.1016/S2468-2667(24)00132-4
Data Access Statement: The extracted data will be shared on request from the corresponding author via email, kathryn.bush@newcastle.ac.uk
PubMed id: 39095136
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