Assessing the extent and determinants of socioeconomic inequalities in epilepsy in the UK: a systematic review and meta-analysis of evidence.

Autor:	Bush KJ; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK. Electronic address: kathryn.bush@newcastle.ac.uk., Cullen E; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK., Mills S; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK., Chin RFM; Muir Maxwell Epilepsy Centre, Department of Child Life and Health and the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK., Thomas RH; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK., Kingston A; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK., Pickrell WO; Swansea University Medical School, Swansea University, Swansea, UK; Neurology Department, Swansea Bay University Health Board, Morriston Hospital, Swansea, UK., Ramsay SE; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Jazyk:	angličtina
Zdroj:	The Lancet. Public health [Lancet Public Health] 2024 Aug; Vol. 9 (8), pp. e614-e628.
DOI:	10.1016/S2468-2667(24)00132-4
Abstrakt:	Background: 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]; I 2 =85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I 2 =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]; I 2 =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. Competing Interests: Declaration of interests RHT has received honoraria from Angelini/Arvelle, Bial, Biocodex, Eisai, Jazz/GW Pharma, LivaNova, NeuraxPharm, Sanofi, Takeda, UCB Pharma, UNEEG, and Zogenix; has received unrestricted research funding from Angelini/Arvelle; and his NHS Hospital Trust has entered into a joint working agreement with UCB Pharma. WOP has received honoraria from Angelini/Arvelle and UCB Pharma and unrestricted research funding from UCB Pharma. RFMC has received honoraria from UCB Pharma, Eisai, Jazz/GW Pharmaceuticals, Biocodex, and Zogenix and his institution has received educational grants from UCB and Jazz Pharmaceuticals. KJB, SER, AK, EC, and SM declare no competing interests. (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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