Socioeconomic differences in use of antiseizure medication in pregnancies with maternal epilepsy: A population-based study from Nordic universal health care systems.

Autor: Leinonen MK; Finnish Institute for Health and Welfare, Knowledge Brokers, Helsinki, Finland.; Department of Neurology, Aarhus University Hospital, Affiliated Member of the European Reference Network EpiCARE, Aarhus, Denmark., Igland J; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.; Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway., Dreier JW; National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark., Alvestad S; Department of Clinical Medicine, University of Bergen, Bergen, Norway.; National Centre for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Oslo, Norway., Cohen JM; Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway., Gilhus NE; Department of Clinical Medicine, University of Bergen, Bergen, Norway.; Department of Neurology, Haukeland University Hospital, Bergen, Norway., Gissler M; Finnish Institute for Health and Welfare, Knowledge Brokers, Helsinki, Finland.; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden., Sun Y; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark., Tomson T; Department of Clinical Neuroscience, Karolinska Institutet, and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden., Zoega H; School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland., Vegrim HM; Department of Clinical Medicine, University of Bergen, Bergen, Norway., Christensen J; Department of Neurology, Aarhus University Hospital, Affiliated Member of the European Reference Network EpiCARE, Aarhus, Denmark.; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Bjørk MH; Department of Clinical Medicine, University of Bergen, Bergen, Norway.; Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Jazyk: angličtina
Zdroj: Epilepsia [Epilepsia] 2024 Aug; Vol. 65 (8), pp. 2397-2411. Date of Electronic Publication: 2024 May 28.
DOI: 10.1111/epi.18022
Abstrakt: Objective: Research points to disparities in disease burden and access to medical care in epilepsy. We studied the association between socioeconomic status (SES) and antiseizure medication (ASM) use in pregnancies with maternal epilepsy.
Methods: We conducted a cross-sectional study consisting of 21 130 pregnancies with maternal epilepsy identified from Nordic registers during 2006-2017. SES indicators included cohabitation status, migrant background, educational attainment, and household income. Main outcomes were the proportion and patterns of ASM use from 90 days before pregnancy to birth. We applied multiple imputation to handle SES variables with 2%-4% missingness. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using modified Poisson regression with the highest SES category as reference.
Results: Mothers with the highest education and the highest income quintile used ASMs least frequently (56% and 53%, respectively). We observed increased risks of ASM discontinuation prior to or during the first trimester for low SES. The risk estimates varied depending on the SES indicator from aRR = 1.27 for low income (95% CI: 1.03-1.57) to aRR = 1.66 for low education (95% CI: 1.30-2.13). Migrant background was associated with ASM initiation after the first trimester (aRR 2.17; 95% CI 1.88-2.52). Low education was associated with the use of valproate during pregnancy in monotherapy (aRR 1.70; 95% CI 1.29-2.24) and in polytherapy (aRR 2.65; 95% CI 1.66-4.21). Low education was also associated with a 37% to 39% increased risk of switching from one ASM to another depending on the ASM used. For the other SES indicators, aRRs of switching varied from 1.16 (foreign origin; 95% CI 1.08-1.26) to 1.26 (not married or cohabiting; 95% CI 1.17-1.36).
Significance: Low SES was associated with riskier patterns of ASM use: discontinuation, late initiation, and switching during pregnancy. These findings may reflect unplanned pregnancies, disparities in access to preconception counseling, and suboptimal care.
(© 2024 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)
Databáze: MEDLINE
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