Last data update: Nov 11, 2024. (Total: 48109 publications since 2009)
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Barriers to and Disparities in Access to Health Care Among Adults Aged ≥18 Years with Epilepsy - United States, 2015 and 2017.
Tian N , Kobau R , Zack MM , Greenlund KJ . MMWR Morb Mortal Wkly Rep 2022 71 (21) 697-702 Approximately 3 million U.S. adults have active epilepsy (i.e., self-reported doctor-diagnosed history of epilepsy and currently taking epilepsy medication or have had at least one seizure in the past year, or both) (1). One of the most common brain disorders, epilepsy poses a number of challenges for people living with this condition because its treatment can be complex, daily management might be inadequate to achieve seizure control, it limits social participation, and epilepsy is associated with early mortality.() Previous studies indicate that persons with epilepsy are more likely to experience barriers or delays in receipt of certain types of care, including epilepsy specialty care, and that these delays are often associated with individual factors (e.g., seizure type) or social determinants of health (e.g., household income or provider availability) (2-4). To obtain updated estimates of access to health care among U.S. adults aged 18 years by epilepsy status, CDC analyzed pooled data from the 2015 and 2017 National Health Interview Survey (NHIS), the most recent years with available epilepsy data. Age-adjusted analyses comparing adults with active epilepsy or inactive epilepsy (i.e., self-reported doctor-diagnosed epilepsy but not currently taking medication for epilepsy and have had no seizure in the past year) with adults without epilepsy indicated that adults with active or inactive epilepsy were more likely to have Medicaid or other public insurance coverage and to report an inability to afford prescription medicine, specialty care, or vision or dental care. Adults with active or inactive epilepsy were more likely to take less medication than prescribed to save money, to be in families having problems paying medical bills, and to report delaying care because of insufficient transportation. Enhancing linkages between clinical and community programs and services by public health practitioners and epilepsy health and social service providers can address gaps in access to health care. |
Seizure- or Epilepsy-Related Emergency Department Visits Before and During the COVID-19 Pandemic - United States, 2019-2021.
Sapkota S , Caruso E , Kobau R , Radhakrishnan L , Jobst B , DeVies J , Tian N , Hogan RE , Zack MM , Pastula DM . MMWR Morb Mortal Wkly Rep 2022 71 (21) 703-708 Seizures, transient signs or symptoms caused by abnormal surges of electrical activity in the brain, can result from epilepsy, a neurologic disorder characterized by abnormal electrical brain activity causing recurrent, unprovoked seizures, or from other inciting causes, such as high fever or substance abuse (1). Seizures generally account for approximately 1% of all emergency department (ED) visits (2,3). Persons of any age can experience seizures, and outcomes might range from no complications for those with a single seizure to increased risk for injury, comorbidity, impaired quality of life, and early mortality for those with epilepsy (4). To examine trends in weekly seizure- or epilepsy-related (seizure-related) ED visits(†) in the United States before and during the COVID-19 pandemic, CDC analyzed data from the National Syndromic Surveillance Program (NSSP).(§) Seizure-related ED visits decreased abruptly during the early pandemic period. By the end of 2020, seizure-related ED visits returned almost to prepandemic levels for persons of all ages, except children aged 0-9 years. By mid-2021, however, this age group gradually returned to baseline as well. Reasons for the decrease in seizure-related ED visits in 2020 among all age groups and the slow return to baseline among children aged 0-9 years compared with other age groups are unclear. The decrease might have been associated with fear of exposure to COVID-19 infection in EDs deterring parents or guardians of children from seeking care, adherence to mitigation measures including avoiding public settings such as EDs, or increased access to telehealth services decreasing the need for ED visits (5). These findings reinforce the importance of understanding factors associated with ED avoidance among persons with epilepsy or seizure, the importance that all eligible persons be up to date(¶) with COVID-19 vaccination, and the need to encourage persons to seek appropriate care for seizure-related emergencies** to prevent adverse outcomes. |
Drivers of US healthcare spending for persons with seizures and/or epilepsies, 2010-2018
Moura Lmvr , Karakis I , Zack MM , Tian N , Kobau R , Howard D . Epilepsia 2022 63 (8) 2144-2154 OBJECTIVE: To characterize spending for persons classified with seizure or epilepsy and determine if spending has increased over time. METHODS: In this cross-sectional study we pooled data from the Medical Expenditure Panel Survey (MEPS) household component files for 2010 to 2018. We matched cases to controls on age and sex of a population-based sample of MEPS respondents (community-dwelling persons of all ages) with records associated with a medical event (e.g., outpatient visit; hospital inpatient) for seizure, epilepsy, or both. Outcomes were weighted to be representative of the civilian, non-institutionalized population. We estimated the treated prevalence of epilepsy and seizure, healthcare spending overall and by site of care, and trends in spending growth. RESULTS: We identified 1,078 epilepsy cases, and 2,344 seizure cases. Treated prevalence was 0.38% (95% CI =0.34-0.41) for epilepsy, 0.76% (95% CI=0.71-0.81) for seizure, and 1.14% (95% CI: 1.08-1.20) for epilepsy or seizure. The difference in annual spending for cases compared to controls was $4,580 (95% CI: $3,362-$5,798) for epilepsy, $7,935 (95% CI: $6,237-$9,634) for seizure, and $6,853 (95% CI: $5,623-$8,084) for epilepsy or seizure, translating into aggregate costs of $5.4 billion, $19.0 billion, and $24.5 billion. From 2010 to 2018, the annual growth rate in total spending incurred for seizures and/or epilepsies was 7.6% compared to 3.6% among controls. SIGNIFICANCE: U.S. economic burden of seizures and/or epilepsies is substantial and warrants interventions focused on their unique and overlapping causes. |
When and why US primary care providers do and do not refer their patients with new-onset seizures or existing epilepsy or seizure disorders to neurologists-2018 DocStyles
Kobau R , Zack MM , Sapkota S , Sajatovic M , Kiriakopoulos E . Epilepsy Behav 2021 125 108385 Monitoring primary care providers' (PCP) attitudes and experiences with referrals of their patients with new-onset seizures or existing epilepsy/seizure disorders may help evaluate whether interventions to coordinate PCP and neurology care reduce treatment gaps and improve patient outcomes. To examine PCPs' attitudes toward, and experiences with, referral to specialty care of their patients with new-onset seizures or existing epilepsy/seizure disorders, we used cross-sectional 2018 DocStyles data to examine study outcomes. We selected a subsample of respondents who had a practice with at least 1% of patients with an epilepsy/seizure disorder and who answered questions about this disorder. We stratified provider actions, referral behavior, and referral enabling factors and barriers by epilepsy/seizure disorder caseload and provider type. We examined different patterns of responses by referral behavior and provider type. The final sample (n = 1284) included 422 family practitioners, 432 internists, 233 pediatricians, and 197 nurse practitioners. Most PCPs refer their patients with new-onset seizures to a neurologist, particularly to determine or confirm the diagnosis and appropriate treatment. Strikingly, about 40% of PCPs did not indicate a referral if their epilepsy/seizure disorder patient was unresponsive to treatment. Internists less likely referred their patients than pediatricians, nurse practitioners, or family practitioners. Less than one-third of all practitioners consulted seizure treatment guidelines. Prompt appointments, communication with the PCP, the patient's insurance, and referral back to primary care may facilitate referrals. Interventions that enhance enabling factors for guidelines-based care and that can increase opportunities for PCPs to consult with neurologists and/or refer their patients with uncontrolled seizures to specialty care are warranted. |
Sleep duration and quality among U.S. adults with epilepsy: National Health Interview Survey 2013, 2015, and 2017
Tian N , Wheaton AG , Zack M , Croft JB , Greenlund KJ . Epilepsy Behav 2021 122 108194 BACKGROUND: Epilepsy is associated with a high prevalence of sleep disturbance. However, population-based studies on the burden of sleep disturbance in people with epilepsy are limited. This study assessed sleep duration and sleep quality by epilepsy status in the general U.S. adult population aged ≥ 18 years. METHODS: We pooled data of cross-sectional National Health Interview Surveys in 2013, 2015, and 2017 to compare the prevalence of sleep duration and quality among those without epilepsy (N = 93,126) with those with any epilepsy (a history of physician-diagnosed epilepsy) (N = 1774), those with active epilepsy (those with a history of physician-diagnosed epilepsy who were currently taking medication to control it, had one or more seizures in the past year, or both) (N = 1101), and those with inactive epilepsy (those with a history of physician-diagnosed epilepsy who were neither taking medication for epilepsy nor had had a seizure in the past year) (N = 673). We also compared these measures between those with active and those with inactive epilepsy. The prevalences were adjusted for sociodemographics, behaviors, and health covariates, with multivariable logistic regression. We used Z-tests to compare prevalences of sleep duration and quality at the statistical significance level of 0.05. RESULTS: Adults with any epilepsy reported significantly higher adjusted prevalences of short sleep duration (<7 h) (36.0% vs. 31.8%) and long sleep duration (>9 h per day) (6.7% vs. 3.7%) but a lower prevalence of healthy sleep duration (7-9 h per day) (57.4% vs.64.6%) than those without epilepsy. In the past week, adults with any epilepsy reported significantly higher adjusted prevalences than adults without epilepsy of having trouble falling asleep (25.0% vs. 20.3%), staying asleep (34.4% vs. 26.3%), nonrestorative sleep (adults did not wake up feeling well rested) (≥3days) (50.3% vs. 44.3%), and taking medication to help themselves fall asleep or stay asleep (≥1 times) (20.9% vs. 13.5%). However, adults with active epilepsy did not differ from adults with inactive epilepsy with respect to these sleep duration and quality measures. CONCLUSIONS: Adults with epilepsy reported more short or long sleep duration and worse sleep quality than those without epilepsy. Neither seizure occurrence nor antiepileptic drug use accounted for these differences in sleep duration and quality. Careful screening for sleep complaints as well as identifying and intervening on the modifiable risk factors associated with sleep disturbances among people with epilepsy could improve epilepsy outcomes and quality of life. |
In 2016, Medicaid and Medicare paid about 65% of all inpatient hospitalization costs for all-age persons hospitalized with epilepsy as the principal diagnosis
Kobau R , Boring M , Zack MM , Croft JB . Epilepsy Behav 2020 114 107601 The purpose of this study was to examine both the distribution of payers for inpatient hospitalizations (all-ages) by principal diagnosis status (epilepsy versus nonepilepsy) and selected organizational- and community-level factors associated with hospitalizations using the Agency for Healthcare Research and Quality's (AHRQ) Healthcare Utilization Project 2016 National Inpatient Sample (NIS) database. We compared cases with epilepsy (any ICD-10CM diagnostic code beginning with "G40") as a principal diagnosis ("epilepsy discharges") versus cases without epilepsy as the principal diagnosis ("nonepilepsy discharges"). Accounting for the complex survey design, we examined how the principal payer source, median income for Zip Code, admission type, hospital location, teaching status, and hospital region varied by principal diagnosis status. For persons of all ages with epilepsy as a principal diagnosis, Medicaid and Medicare public insurance paid for about 65% of inpatient hospitalization costs. The percentage paid by Medicaid among epilepsy discharges (31.6%) significantly exceeded that among nonepilepsy discharges (23.1%). The percentage paid by Medicare among epilepsy discharges (33.9%) was significantly less than that among nonepilepsy discharges (39.7%), as was payment by private insurers (26.1% vs. 30.1%). Median Zip Code income, hospital and admission characteristics, and geographic region differed between hospitalizations with epilepsy versus those with a nonepilepsy discharge. These findings may be used to inform stakeholders' understanding of epilepsy care-related costs and factors associated with hospitalizations for improved interventions and programs. |
Knowledge of and familiarity with epilepsy in U.S. adults: Results from the 2017 ConsumerStyles Online Panel Survey
Kobau R , Zack MM . Epilepsy Behav 2020 114 107535 Examining and improving knowledge and attitudes about epilepsy has been a public health priority because of stigma around the disorder. This study had three goals: (1) to update estimates describing U.S. adults' perceived knowledge about epilepsy, seizure first aid, and confidence in providing seizure first aid; (2) to examine U.S. adults' recognition of common signs and symptoms of generalized and focal seizures to inform public awareness efforts; and (3) to provide baseline estimates of exposure to an Epilepsy Foundation public awareness campaign, #ShareMySeizure, launched in November, 2016. Four sets of epilepsy questions were included on the 2017 Porter Novelli ConsumerStyles survey, an online panel survey of the U.S. adult population. We examined differences in study outcomes by sociodemographic factors and familiarity with someone with epilepsy. Small percentages of U.S. adults felt knowledgeable about epilepsy (16%), knew seizure first aid (25%), or reported having confidence in being able to help someone having a seizure with appropriate seizure first aid (20%). Fewer adults were familiar with signs of focal seizures compared to generalized seizures. About 1% of U.S. adults had heard of the #ShareMySeizure campaign. Television and family and friends emerged as the most common sources of information for those who reported hearing something about epilepsy. About 33% of U.S. adults wanted to learn more about epilepsy. Knowledge about epilepsy among the U.S. public is suboptimal, though generally on par with that of more common conditions such as heart disease, eye conditions, and ovarian cancer. U.S. adults need and want more information about epilepsy, appropriate seizure first aid training, and recognition of seizure symptoms. |
Prevalence and trends in cigarette smoking among adults with epilepsy - United States, 2010-2017
Sapkota S , Kobau R , Croft JB , King BA , Thomas C , Zack MM . MMWR Morb Mortal Wkly Rep 2020 69 (47) 1792-1796 Cigarette smoking remains the leading cause of preventable disease and death in the United States (1). Although the percentage of all U.S. adults who smoke cigarettes has declined substantially since the mid-1960s (1,2), marked disparities persist, and declines have not been consistent across population groups (1,2). Studies have shown that cigarette smoking is as common, and sometimes more so, among adults with a history of epilepsy compared with those without a history of epilepsy, but reasons for this are unclear (3-6). Compared with adults without epilepsy, adults with epilepsy report lower household income, more unemployment and disability, worse psychological health, and reduced health-related quality of life (3,4,6,7). Trends in cigarette smoking among U.S. adults with epilepsy have not been previously assessed. CDC analyzed National Health Interview Survey (NHIS) data among 121,497 U.S. adults from 2010, 2013, 2015, and 2017 to assess current cigarette smoking by epilepsy status. From 2010 through 2017, the age-standardized percentages of current smoking were 24.9% among adults with active epilepsy, 25.9% among adults with inactive epilepsy, and 16.6% among adults with no history of epilepsy. After accounting for differences in data collection intervals and patterns in smoking status among subgroups, CDC found that current cigarette smoking declined significantly from 2010 to 2017 among adults with no history of epilepsy (19.3% to 14.0% [p<0.001]) and inactive epilepsy (29.2% to 16.2% [p = 0.03]), but declines among adults with active epilepsy were not statistically significant (26.4% to 21.8% [p = 0.2]). Epilepsy health and social service providers should promote smoking cessation resources to adults with active epilepsy who smoke cigarettes to help them quit smoking and to reduce their risk of smoking-related disease and death. |
COVID-19 Contact Tracing in Two Counties - North Carolina, June-July 2020.
Lash RR , Donovan CV , Fleischauer AT , Moore ZS , Harris G , Hayes S , Sullivan M , Wilburn A , Ong J , Wright D , Washington R , Pulliam A , Byers B , McLaughlin HP , Dirlikov E , Rose DA , Walke HT , Honein MA , Moonan PK , Oeltmann JE . MMWR Morb Mortal Wkly Rep 2020 69 (38) 1360-1363 Contact tracing is a strategy implemented to minimize the spread of communicable diseases (1,2). Prompt contact tracing, testing, and self-quarantine can reduce the transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (3,4). Community engagement is important to encourage participation in and cooperation with SARS-CoV-2 contact tracing (5). Substantial investments have been made to scale up contact tracing for COVID-19 in the United States. During June 1-July 12, 2020, the incidence of COVID-19 cases in North Carolina increased 183%, from seven to 19 per 100,000 persons per day* (6). To assess local COVID-19 contact tracing implementation, data from two counties in North Carolina were analyzed during a period of high incidence. Health department staff members investigated 5,514 (77%) persons with COVID-19 in Mecklenburg County and 584 (99%) in Randolph Counties. No contacts were reported for 48% of cases in Mecklenburg and for 35% in Randolph. Among contacts provided, 25% in Mecklenburg and 48% in Randolph could not be reached by telephone and were classified as nonresponsive after at least one attempt on 3 consecutive days of failed attempts. The median interval from specimen collection from the index patient to notification of identified contacts was 6 days in both counties. Despite aggressive efforts by health department staff members to perform case investigations and contact tracing, many persons with COVID-19 did not report contacts, and many contacts were not reached. These findings indicate that improved timeliness of contact tracing, community engagement, and increased use of community-wide mitigation are needed to interrupt SARS-CoV-2 transmission. |
Multiple COVID-19 Clusters on a University Campus - North Carolina, August 2020.
Wilson E , Donovan CV , Campbell M , Chai T , Pittman K , Seña AC , Pettifor A , Weber DJ , Mallick A , Cope A , Porterfield DS , Pettigrew E , Moore Z . MMWR Morb Mortal Wkly Rep 2020 69 (39) 1416-1418 Preventing transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), in institutes of higher education presents a unique set of challenges because of the presence of congregate living settings and difficulty limiting socialization and group gatherings. Before August 2020, minimal data were available regarding COVID-19 outbreaks in these settings. On August 3, 2020, university A in North Carolina broadly opened campus for the first time since transitioning to primarily remote learning in March. Consistent with CDC guidance at that time (1,2), steps were taken to prevent the spread of SARS-CoV-2 on campus. During August 3-25, 670 laboratory-confirmed cases of COVID-19 were identified; 96% were among patients aged <22 years. Eighteen clusters of five or more epidemiologically linked cases within 14 days of one another were reported; 30% of cases were linked to a cluster. Student gatherings and congregate living settings, both on and off campus, likely contributed to the rapid spread of COVID-19 within the university community. On August 19, all university A classes transitioned to online, and additional mitigation efforts were implemented. At this point, 334 university A-associated COVID-19 cases had been reported to the local health department. The rapid increase in cases within 2 weeks of opening campus suggests that robust measures are needed to reduce transmission at institutes of higher education, including efforts to increase consistent use of masks, reduce the density of on-campus housing, increase testing for SARS-CoV-2, and discourage student gatherings. |
Frequent mental distress among adults, by disability status, disability type, and selected characteristics - United States, 2018
Cree RA , Okoro CA , Zack MM , Carbone E . MMWR Morb Mortal Wkly Rep 2020 69 (36) 1238-1243 Frequent mental distress, defined as 14 or more self-reported mentally unhealthy days in the past 30 days,* is associated with adverse health behaviors, increased use of health services, mental disorders (e.g., diagnosis of major depressive disorder), chronic diseases, and functional limitations (1). Adults with disabilities more often report depression and anxiety (2), reduced health care access (3), and health-related risk behaviors (4) than do adults without disabilities. CDC analyzed 2018 Behavioral Risk Factor Surveillance System (BRFSS) data to compare the prevalence of frequent mental distress among adults with disabilities with that among adults without disabilities and to identify factors associated with mental distress among those with disabilities. Nationwide, an estimated 17.4 million adults with disabilities reported frequent mental distress; the prevalence of reported mental distress among those with disabilities (32.9%) was 4.6 times that of those without disabilities (7.2%). Among adults with disabilities, those with both cognitive and mobility disabilities most frequently reported mental distress (55.6%). Adults with disabilities who reported adverse health-related characteristics (e.g., cigarette smoking, physical inactivity, insufficient sleep, obesity, or depressive disorders) or an unmet health care need because of cost also reported experiencing more mental distress than did those with disabilities who did not have these characteristics. Adults living below the federal poverty level reported mental distress 70% more often than did adults in higher income households. Among states, age-adjusted prevalence of mental distress among adults with disabilities ranged from 25.2% (Alaska) to 42.9% (New Hampshire). Understanding the prevalence of mental distress among adults with disabilities could help health care providers, public health professionals, and policy makers target interventions and inform programs and policies to ensure receipt of mental health screening, care, and support services to reduce mental distress among adults with disabilities. |
Trends in Number and Distribution of COVID-19 Hotspot Counties - United States, March 8-July 15, 2020.
Oster AM , Kang GJ , Cha AE , Beresovsky V , Rose CE , Rainisch G , Porter L , Valverde EE , Peterson EB , Driscoll AK , Norris T , Wilson N , Ritchey M , Walke HT , Rose DA , Oussayef NL , Parise ME , Moore ZS , Fleischauer AT , Honein MA , Dirlikov E , Villanueva J . MMWR Morb Mortal Wkly Rep 2020 69 (33) 1127-1132 The geographic areas in the United States most affected by the coronavirus disease 2019 (COVID-19) pandemic have changed over time. On May 7, 2020, CDC, with other federal agencies, began identifying counties with increasing COVID-19 incidence (hotspots) to better understand transmission dynamics and offer targeted support to health departments in affected communities. Data for January 22-July 15, 2020, were analyzed retrospectively (January 22-May 6) and prospectively (May 7-July 15) to detect hotspot counties. No counties met hotspot criteria during January 22-March 7, 2020. During March 8-July 15, 2020, 818 counties met hotspot criteria for ≥1 day; these counties included 80% of the U.S. population. The daily number of counties meeting hotspot criteria peaked in early April, decreased and stabilized during mid-April-early June, then increased again during late June-early July. The percentage of counties in the South and West Census regions* meeting hotspot criteria increased from 10% and 13%, respectively, during March-April to 28% and 22%, respectively, during June-July. Identification of community transmission as a contributing factor increased over time, whereas identification of outbreaks in long-term care facilities, food processing facilities, correctional facilities, or other workplaces as contributing factors decreased. Identification of hotspot counties and understanding how they change over time can help prioritize and target implementation of U.S. public health response activities. |
Epilepsy and chronic obstructive pulmonary disease among U.S. adults: National Health Interview Survey 2013, 2015, and 2017
Tian N , Zack M , Wheaton AG , Greenlund KJ , Croft JB . Epilepsy Behav 2020 110 107175 BACKGROUND: Among U.S. adults, over 4 million report a history of epilepsy, and more than 15 million report a history of chronic obstructive pulmonary disease (COPD); Chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema, is a common somatic comorbidity of epilepsy. This study assessed the relationship between self-reported physician-diagnosed epilepsy and COPD in a large representative sample of the U.S. adult population and explored possible mechanisms. METHODS: Cross-sectional National Health Interview Surveys for 2013, 2015, and 2017 were aggregated to compare the prevalence of COPD between U.S. respondents aged >/=18years with a history of physician-diagnosed epilepsy (n=1783) and without epilepsy (n=93,126). We calculated prevalence of COPD by age-standardized adjustment and prevalence ratios of COPD overall adjusted for sociodemographic and risk factors, by using multivariable logistic regression analyses. A Z-test was conducted to compare the prevalence between people with and without epilepsy at the statistical significance level of 0.05. Prevalence ratios whose 95% confidence intervals did not overlap 1.00 were considered statistically significant. RESULTS: The overall age-standardized prevalence was 5.7% for COPD and 1.8% for epilepsy. Age-standardized prevalence of COPD among respondents with epilepsy (15.4%) exceeded that among those without epilepsy (5.5%). The association remained significantly different among all sociodemographic and risk factor subgroups (p<.05). In the adjusted analyses, epilepsy was also significantly associated with COPD, overall (adjusted prevalence ratio=1.8, 95% confidence interval=1.6-2.1) and in nearly all subgroups defined by selected characteristics. CONCLUSIONS: Epilepsy is associated with a higher prevalence of COPD in U.S. adults. Public health interventions targeting modifiable behavioral and socioeconomic risk factors among people with epilepsy may help prevent COPD and related premature death. |
CDC-supported epilepsy surveillance and epidemiologic studies: A review of progress since 1994
Tian N , Croft JB , Kobau R , Zack MM , Greenlund KJ . Epilepsy Behav 2020 109 107123 To report progress, to identify gaps, and to plan epilepsy surveillance and research activities more effectively, the Centers for Disease Control and Prevention (CDC) Epilepsy Program has summarized findings from selected CDC-supported surveillance and epidemiologic studies about epilepsy from 1994 through 2019. We identified publications supported by CDC funding and publications conducted by the CDC Epilepsy Program alone or with partners. We included only epilepsy surveillance and epidemiologic studies focusing on epilepsy burden, epilepsy-related outcomes, and healthcare utilization. We describe the findings of these studies in the following order: 1)prevalence; 2)incidence; 3)epilepsy-related outcomes by selected demographic characteristics; 4)cysticercosis or neurocysticercosis (NCC); 5)traumatic brain injury (TBI); 6)comorbidity; 7)mortality; 8)access to care; 9)quality of care; and 10) cost. We have characterized these findings in relation to the scope of the first three domains of the 2012 Institute of Medicine report on epilepsy and its relevant first four recommendations. From 1994 through 2019, 76 publications on epilepsy-related epidemiologic and surveillance studies were identified. Over the past 25years, CDC has expanded community, state, and national surveillance on epilepsy and supported epidemiologic studies by using multiple assessment methods and validated case-ascertainment criteria to identify epilepsy burden, epilepsy-related outcomes, and healthcare utilization in the general population or in population subgroups. Among identified research opportunities, studies on epilepsy incidence and risk factors, mortality, and cost are considered as important surveillance gaps. Other remaining gaps and suggested surveillance strategies are also proposed. Findings from this review may help epilepsy researchers and other stakeholders reference and prioritize future activities for epidemiologic and surveillance studies in epilepsy. |
COVID-19 Among Workers in Meat and Poultry Processing Facilities - 19 States, April 2020.
Dyal JW , Grant MP , Broadwater K , Bjork A , Waltenburg MA , Gibbins JD , Hale C , Silver M , Fischer M , Steinberg J , Basler CA , Jacobs JR , Kennedy ED , Tomasi S , Trout D , Hornsby-Myers J , Oussayef NL , Delaney LJ , Patel K , Shetty V , Kline KE , Schroeder B , Herlihy RK , House J , Jervis R , Clayton JL , Ortbahn D , Austin C , Berl E , Moore Z , Buss BF , Stover D , Westergaard R , Pray I , DeBolt M , Person A , Gabel J , Kittle TS , Hendren P , Rhea C , Holsinger C , Dunn J , Turabelidze G , Ahmed FS , deFijter S , Pedati CS , Rattay K , Smith EE , Luna-Pinto C , Cooley LA , Saydah S , Preacely ND , Maddox RA , Lundeen E , Goodwin B , Karpathy SE , Griffing S , Jenkins MM , Lowry G , Schwarz RD , Yoder J , Peacock G , Walke HT , Rose DA , Honein MA . MMWR Morb Mortal Wkly Rep 2020 69 (18) Congregate work and residential locations are at increased risk for infectious disease transmission including respiratory illness outbreaks. SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is primarily spread person to person through respiratory droplets. Nationwide, the meat and poultry processing industry, an essential component of the U.S. food infrastructure, employs approximately 500,000 persons, many of whom work in proximity to other workers (1). Because of reports of initial cases of COVID-19, in some meat processing facilities, states were asked to provide aggregated data concerning the number of meat and poultry processing facilities affected by COVID-19 and the number of workers with COVID-19 in these facilities, including COVID-19-related deaths. Qualitative data gathered by CDC during on-site and remote assessments were analyzed and summarized. During April 9-27, aggregate data on COVID-19 cases among 115 meat or poultry processing facilities in 19 states were reported to CDC. Among these facilities, COVID-19 was diagnosed in 4,913 (approximately 3%) workers, and 20 COVID-19-related deaths were reported. Facility barriers to effective prevention and control of COVID-19 included difficulty distancing workers at least 6 feet (2 meters) from one another (2) and in implementing COVID-19-specific disinfection guidelines.* Among workers, socioeconomic challenges might contribute to working while feeling ill, particularly if there are management practices such as bonuses that incentivize attendance. Methods to decrease transmission within the facility include worker symptom screening programs, policies to discourage working while experiencing symptoms compatible with COVID-19, and social distancing by workers. Source control measures (e.g., the use of cloth face covers) as well as increased disinfection of high-touch surfaces are also important means of preventing SARS-CoV-2 exposure. Mitigation efforts to reduce transmission in the community should also be considered. Many of these measures might also reduce asymptomatic and presymptomatic transmission (3). Implementation of these public health strategies will help protect workers from COVID-19 in this industry and assist in preserving the critical meat and poultry production infrastructure (4). |
Timing of suicide in people with epilepsy: A population-based study from 18 states of the United States, 2003-2014
Tian N , Zack MM , Hesdorffer DC . Epilepsy Behav 2019 99 106421 Suicide timing varies across several psychiatric disorders, which may share common underlying pathophysiological mechanisms with epilepsy. We investigated suicide timing in people with epilepsy. Using cross-sectional, population-based U.S. National Violent Death Reporting System data from 2003 through 2014 in 18 States, we identified 1310 suicides with epilepsy and 102,582 suicides without epilepsy among those 10years and older. We compared patterns of suicide mortality ratios between those with and without epilepsy by month of year, week of month, day of week, time of day, and overall by age, sex, and race/ethnicity. As the suicide patterns seen among persons without epilepsy, suicides in persons with epilepsy occurred significantly more often during the morning, afternoon, and evening hours than at night in all subgroups except females. Compared to Sundays, suicides in persons with epilepsy were only significantly increased on Mondays and Tuesdays in those aged >/=45years and only on Mondays in men. This pattern differs from persons without epilepsy whose suicides significantly increased on Mondays and significantly decreased on Saturdays in nearly all study subgroups. Suicides in persons with epilepsy did not exhibit the timing patterns of persons without epilepsy by week of month (significant decreases from the third to fifth weeks compared to the first week among those aged >/=45years, males, and Non-Hispanic whites) and month of year (significant increases from January to November peaking from June to September compared to December in all study groups). Compared to the general population or people without epilepsy, previous and current studies suggest that in people with epilepsy, suicide timing differs from and suicide rates significantly exceed those in people without epilepsy. Preventing suicide in people with epilepsy should focus not only on the peak times of occurrence but also across all time periods. |
National declines in the percentages of uninsured among adults aged 18-64 years with active epilepsy, 2010 and 2013 to 2015 and 2017 - U.S. National Health Interview Survey
Kobau R , Sapkota S , Koh HK , Zack MM . Epilepsy Behav 2019 97 316-318 Epilepsy is more common among children and adults living in households at lowest incomes. Like those living with any complex chronic condition, people with epilepsy need quality healthcare to improve their health and social outcomes. The purpose of this study was to use the latest national data to provide updated estimates of the percentages of adults aged 18-64years with active epilepsy who were uninsured in 2010, 2013, 2015, and 2017 and to examine changes in health insurance coverage during these years. We analyzed nationally representative samples of adults (aged 18-64years) from the 2010, 2013, 2015, and 2017 National Health Interview Survey (NHIS). We used a validated epilepsy surveillance case definition to classify adults as having active epilepsy during 2010 and 2013 (n=507) and during 2015 and 2017 (n=582). We used the NHIS recode variables available in each year that account for a series of questions posed to respondents to confirm coverage and that ultimately classify respondents with different healthcare coverage types. Overall, the percentage of uninsured adults among respondents aged 18-64years with active epilepsy decreased by more than half (59%), from 17.7% (95% confidence interval [CI]=13.6%-22.7%) in 2010 and 2013 to 7.3% (95% CI=4.8%-10.7%) in 2015 and 2017. The decrease in the percentage of uninsured adults with active epilepsy after 2010 and 2013 was balanced by a similar increase in public insurance coverage and private insurance coverage in 2015 and 2017. Epilepsy stakeholders can ensure that all uninsured adults with epilepsy obtain access to health insurance coverage. National Health Interview Survey data on epilepsy, when available, can be used to monitor trends in insurance status in the new decade. |
Prevalence, risk factors, and burden of disease for falls and balance or walking problems among older adults in the U.S
Jia H , Lubetkin EI , DeMichele K , Stark DS , Zack MM , Thompson WW . Prev Med 2019 126 105737 This study assesses the prevalence of falls, factors predicting future falls, and health impacts of falls and balance or walking problems for U.S. older adults. Data were participants >/=65years in the Medicare Health Outcomes Survey Cohort 15 (baseline survey in 2012; follow-up survey in 2014; n=164,597). We examined baseline factors predicting falls at follow-up and estimated the impact of falls and balance/walking problems on health-related quality of life (HRQOL), mortality, and quality-adjusted life years (QALYs). About 23% reported falls and 34% reported balance/walking problems in the past 12months. The strongest predictors of falls were previous falls [adjusted odds ratio (OR)=2.9] and balance/walking problems (OR=1.7). Many self-reported chronic conditions (e.g., depression, stroke, and diabetes), geriatric symptoms (e.g., urine leakage), and limitations of activities of daily living (e.g., transferring and walking) also predicted falls, but at a smaller magnitude (ORs=1.1-1.3). Having balance/walking problems was associated with a greater decrease in HRQOL scores (0.195 points) than falls (0.077 points), while falls were associated with a greater increase in mortality [adjusted hazard ratio (HR)=1.5] than balance/walking problems (HR=1.1). Falls were associated with a 4.6-year (48%) decrease in QALYs, while balance/walking problems was associated with a 7.3-year (62%) decrease in QALYs. Falls are a major problem for U.S. elderly and will continue to have an even greater impact as the population ages. The nearly 50% decrease in QALYs for falls and >60% decrease for balance or walking problems demonstrates the substantial burden associated with these problems among older Americans. |
Quality-adjusted life years (QALYs) associated with limitations in activities of daily living (ADL) in a large longitudinal sample of the U.S. community-dwelling older population
Jia H , Lubetkin EI , DeMichele K , Stark DS , Zack MM , Thompson WW . Disabil Health J 2019 12 (4) 699-705 BACKGROUND: The staging method for activities of daily living (ADLs) limitations developed by Stineman and colleagues that classifies people into five stages can reflect severity of activity limitations. OBJECTIVE: To assess the impact of stages of limitations in ADLs on quality-adjusted life years (QALYs) and the relative severity of each ADL limitation for a large, nationally-representative sample of the U.S. community-dwelling older population. METHODS: Data were obtained from the Limited Dataset of the Medicare Health Outcomes Survey Cohort 15 (2012 baseline survey, 2014 follow-up survey). We included respondents aged >/=65 years (n=105,473). We estimated expected QALYs throughout the remaining lifetime of participants stratified by the ADL limitation status and stages of ADL limitations. RESULTS: Overall, the expected QALYs was 5.6 years. QALYs decreased with increasing stages of ADL limitations. The adjusted QALYs for Stage 0 (no limitation) participants were 6.8; for Stage I (mild) participants, 3.9; for Stage II (moderate) participants, 2.2; for Stage III (severe) participants, 1.8; and for Stage IV (complete limitations) participants, 1.5. Differences in QALYs occurred between individual ADL items within an ADL stage. In Stage I, for example, participants who reported only problems with getting in or out of chairs had 6.7 QALYs which was markedly higher than participants who reported only problems with walking (3.8 QALYs). CONCLUSIONS: Our findings provide additional evidence that Stineman's ADL stages serve as valid estimates of the overall health of elderly Americans. Self-reported ADL status should be routinely collected as a patient-reported outcome in the elderly population. |
Serious psychological distress among adults with active epilepsy in all racial/ethnic groups and among adults with inactive epilepsy in non-Hispanic whites is significantly higher than among adults without epilepsy - U.S. National Health Interview Survey, 2010, 2013, 2015, and 2017
Kobau R , Sapkota S , Zack MM . Epilepsy Behav 2019 95 192-194 Serious psychological distress (SPD) includes mental health problems severe enough to cause moderate-to-serious impairment in daily activities and to require treatment. Serious psychological distress is based on answers to six survey questions from the Kessler-6 scale used internationally in public health surveillance systems to assess recent feelings of sadness, restlessness, hopelessness, nervousness, worthlessness, and the sense that everything is an effort. We combined nationally representative samples in the National Health Interview Survey (NHIS) from 2010 (N=27,157), 2013 (N=34,557), 2015 (N=33,672), and 2017 (N=26,742). We used a validated surveillance case definition to classify adults as having epilepsy if they reported a history of doctor-diagnosed epilepsy or seizure disorder (n=2251). We further classified those with epilepsy as having active epilepsy (n=1380) if they reported either taking epilepsy medications or having at least one seizure in the past 12months or as having inactive epilepsy (n=871) if they did not take epilepsy medication and had not had any seizures in the past 12months. We used an NHIS recoded variable that classifies adults by Hispanic origin and race. Following age adjustment, among adults with active epilepsy, SPD prevalence was 13.7% among non-Hispanic white adults, 11.2% among non-Hispanic black adults, 20.7% among Hispanic adults, and 17.5% among non-Hispanic other adults. Compared with adults without epilepsy, adults with active epilepsy were 4.8 times more likely, and adults with inactive epilepsy 2.6 times more likely, to report SPD. In each racial/ethnic group, SPD among adults with active epilepsy is significantly higher than in adults without epilepsy. Among adults with active epilepsy, SPD prevalence did not differ by racial/ethnic groups. However, only among non-Hispanic white adults with inactive epilepsy did SPD prevalence significantly exceed that among non-Hispanic white adults without epilepsy. Epilepsy stakeholders can use these estimates to target culturally appropriate community-based and clinic-based interventions to reduce the high burden of psychological distress among adults with active epilepsy and inactive epilepsy. |
Comparing the performance of 2 health utility measures in the Medicare Health Outcome Survey (HOS)
Jia H , Lubetkin EI , DeMichele K , Stark DS , Zack MM , Thompson WW . Med Decis Making 2018 38 (8) 983-993 BACKGROUND: The Medicare Health Outcomes Survey (HOS), a nationwide annual survey of Medicare beneficiaries, includes the Centers for Disease Control and Prevention's HRQOL-4 questionnaire and Veterans RAND 12-item Health Survey (VR-12). This study compared EQ-5D scores derived from the HRQOL-4 (dEQ-5D) to SF-6D scores derived from VR-12. METHODS: Data were from Medicare HOS Cohort 15 (2012 baseline; 2014 follow-up). We included participants aged 65+ ( n = 105,473). We compared score distributions, evaluated known-groups validity, assessed each index as a predictor for mortality, and estimated quality-adjusted life years (QALYs) using the dEQ-5D and SF-6D. RESULTS: Compared to the SF-6D, the dEQ-5D had a higher mean score (0.787 v. 0.691) and larger standard deviation (0.310 v. 0.101). The decreases in estimated scores associated with chronic conditions were greater for the dEQ-5D than for the SF-6D. For example, dEQ-5D scores for persons with depression decreased 0.456 points compared to 0.141 points for the SF-6D. The dEQ-5D strongly predicted mortality, as adjusted hazard ratios for the first to fourth quintiles, relative to the fifth quintile, were 2.2, 1.7, 1.8, and 1.5, respectively, while the association between SF-6D and mortality was weaker or nonexistent (adjusted hazard ratios were 1.3, 1.1, 1.0, and 0.6, respectively). Compared to the SF-6D, QALYs estimated using the dEQ-5D were higher overall (5.6 v. 4.9 years), higher for persons with less debilitating conditions (e.g., hypertension, 5.0 v. 4.4 years), and lower for more debilitating conditions (e.g. depression, 2.5 v. 2.8 years). CONCLUSIONS: Compared to the SF-6D, the dEQ-5D was better able to measure individuals' overall health; detect the differential impact of chronic conditions, particularly among persons in poorer health; and predict mortality. The HRQOL-4 questionnaire may be valuable for monitoring and improving health outcomes for the Medical HOS data set. |
Adults with an epilepsy history, notably those 45-64 years old or at the lowest income levels, more often report heart disease than adults without an epilepsy history
Zack M , Luncheon C . Epilepsy Behav 2018 86 208-210 From 95,196 sample adults in the combined 2010, 2013, and 2015 U.S. National Health Interview Survey, we estimated the association between histories of epilepsy and heart disease after accounting for sociodemographic characteristics and behavioral risk factors. Adults 18years old or older with an epilepsy history reported heart disease (21%) about nine percentage points more often than those without such a history (12%), overall and within levels of characteristics and risk factors. These increases in heart disease history for adults with an epilepsy history compared with adults without such a history were greater in those 45-64 years old or at the lowest family income levels. These increases of heart disease in adults with an epilepsy history highlight two needs-to prevent the occurrence of heart disease and to reduce its consequences. Because comorbidity from heart disease can complicate epilepsy management, physicians caring for those with epilepsy should be aware of these increased risks, identify risk factors for heart disease, and recommend to their patients with epilepsy ways to diminish these risks. |
Close to 1 million US adults aged 55 years or older have active epilepsy - National Health Interview Survey, 2010, 2013, and 2015
Sapkota S , Kobau R , Pastula DM , Zack MM . Epilepsy Behav 2018 87 233-234 Epilepsy is common in older adults because known risk factors-such as traumatic brain injury, stroke, cerebrovascular disease, neurodegenerative disorders, and neoplasms-increase with age. This study uses the most recent data from the 2010, 2013, and 2015 National Health Interview Survey (NHIS) to provide updated national estimates of epilepsy prevalence among US adults aged 55years or older to help guide public health action. We used the following validated surveillance case definition for active epilepsy: adults with self-reported doctor-diagnosed epilepsy or seizure disorder who reported either currently taking medications to treat their epilepsy or seizure disorder or at least one seizure during the past 12months. We estimated the prevalence of active epilepsy to be 1.4% (about 529,000) among US adults aged 55-64, 0.9% (225,000) for those aged 65-74, and 1.0% (178,000) for those aged >/=75years. The prevalence of a history of epilepsy and active epilepsy among adults aged 55-64years was significantly higher than the prevalence in older age groups. Collectively, close to 1 million adults aged 55years or older reported active epilepsy. Epilepsy stakeholders should ensure that older adults with epilepsy have access to age-appropriate clinical preventive services, chronic disease self-management support, specialty care for epilepsy and other comorbidities, and appropriate community services to promote quality of life. |
Quality-adjusted life years (QALY) for 15 chronic conditions and combinations of conditions among US adults aged 65 and older
Jia H , Lubetkin EI , Barile JP , Horner-Johnson W , DeMichele K , Stark DS , Zack MM , Thompson WW . Med Care 2018 56 (8) 740-746 BACKGROUND: Although the life expectancy for the US population has increased, a high proportion of this population has lived with >/=1 chronic conditions. We have quantified the burden of disease associated with 15 chronic conditions and combinations of conditions by estimating quality-adjusted life years (QALYs) for older US adults. RESEARCH DESIGN: Data were from the Medicare Health Outcomes Survey Cohort 15 (baseline survey in 2012, follow-up survey 2014, with mortality follow-up through January 31, 2015). We included individuals aged 65 years and older (n=96,481). We estimated mean QALY throughout the remainder of the lifetime according to the occurrence of these conditions. RESULTS: The age-adjusted QALY was 5.8 years for men and 7.8 years for women. Over 90% respondents reported at least 1 condition and 72% reported multiple conditions. Respondents with depression and congestive heart failure had the lowest age-adjusted QALY (1.1-1.5 y for men and 1.5-2.2 y for women), whereas those with hypertension, arthritis, and sciatica had higher QALY (4.2-5.4 and 6.4-7.2 y, respectively). Having either depression or congestive heart failure and any 1 or 2 of the other 13 conditions was associated with the lowest QALY among the possible dyads and triads of chronic conditions. Dyads and triads with hypertension or arthritis were more prevalent, but had higher QALY. CONCLUSIONS: Understanding the burden of disease for common chronic conditions and for combinations of these conditions is useful for delivering high-quality primary care that could be tailored for individuals with combinations of chronic conditions. |
The timing of suicide in 18 United State states from 2003-2014
Tian N , Zack M , Fowler KA , Hesdorffer DC . Arch Suicide Res 2018 23 (2) 1-21 OBJECTIVES: We investigated suicide timing over different time periods by age, sex and race/ethnicity. METHODS: 122,107 suicide deaths were identified from the population-based U.S. National Violent Death Reporting System in 18 U.S. States from 2003 through 2014. RESULTS: Suicides significantly increased (p < 0.05) from March to peak in September before falling, the first week of the month, and early in the week. Suicides also significantly increased (p < 0.05) in the morning, mainly peaking during the afternoon, although suicides in adolescents peaked in the evening and in those 65 years and older peaked in the morning. CONCLUSIONS: Comprehensive prevention efforts should focus on those at overall increased suicide risk and at peaks of high suicide frequency, especially among those vulnerable subgroups. |
Active epilepsy and seizure control in adults - United States, 2013 and 2015
Tian N , Boring M , Kobau R , Zack MM , Croft JB . MMWR Morb Mortal Wkly Rep 2018 67 (15) 437-442 Approximately 3 million American adults reported active epilepsy* in 2015 (1). Active epilepsy, especially when seizures are uncontrolled, poses substantial burdens because of somatic, neurologic, and mental health comorbidity; cognitive and physical dysfunction; side effects of antiseizure medications; higher injury and mortality rates; poorer quality of life; and increased financial cost (2). Thus, prompt diagnosis and seizure control (i.e., seizure-free in the 12 months preceding the survey) confers numerous clinical and social advantages to persons with active epilepsy. To obtain recent and reliable estimates of active epilepsy and seizure control status in the U.S. population, CDC analyzed aggregated data from the 2013 and the 2015 National Health Interview Surveys (NHISs). Overall, an annual estimated 2.6 million (1.1%) U.S. adults self-reported having active epilepsy, 67% of whom had seen a neurologist or an epilepsy specialist in the past year, and 90% of whom reported taking epilepsy medication. Among those taking epilepsy medication, only 44% reported having their seizures controlled. A higher prevalence of active epilepsy and poorer seizure control were associated with low family income, unemployment, and being divorced, separated, or widowed. Use of epilepsy medication was higher among adults who saw an epilepsy specialist in the past year than among those who did not. Health care and public health should ensure that adults with uncontrolled seizures have appropriate care and self-management support in order to promote seizure control, improve health and social outcomes, and reduce health care costs. |
Adults with an epilepsy history, especially those 45years or older, those with lower family incomes, and those with a history of hypertension, report a history of stroke five times as often as adults without such a history - 2010, 2013, and 2015 U.S. National Health Interview Survey
Zack MM , Luncheon C . Epilepsy Behav 2018 83 236-238 Stroke is the 5th leading cause of death and a leading cause of serious, long-term disability, despite being largely preventable in most people [1]. Stroke is also a common and serious cardiovascular comorbidity affecting persons with epilepsy, potentially increasing risk of early mortality [2], [3], [4], [5], [6], [7], [8], [9]. Stroke and epilepsy may be bidirectional, resulting from different causal mechanisms or shared risk factors [3], [10], [11]. Adults with epilepsy or seizures report higher levels of cardiovascular disease risk factors, including smoking, physical inactivity, overweight or obesity, and psychological distress [6], [7]. Stroke prevention in the general population including those with epilepsy is critical to reduce epilepsy and overall disability burden. This report uses three recent population-based U.S. adult samples to estimate how often stroke occurs in adults reporting a history of epilepsy, overall and at different levels of demographic characteristics and stroke risk factors. |
People with epilepsy are diagnosed most often with unspecified epilepsy, followed by focal epilepsy, generalized convulsive epilepsy, and generalized nonconvulsive epilepsy - US MarketScan data, 2010-2015
Sapkota S , Kobau R , Pastula DM , Zack MM . Epilepsy Behav 2017 79 244-246 The distribution of epilepsy types varies by age, etiology, provider diagnostic capabilities, and assessment criteria. No recent US study has examined the distribution of epilepsy types in a large, population-based sample of people with epilepsy. We used MarketScan data from January 1, 2010 through September 30, 2015, to estimate the proportion of epilepsy types among all (N=370,570) individuals diagnosed with epilepsy. We identified cases of epilepsy as individuals with at least one International Classification of Disease, 9th version (ICD-9) diagnostic code of 345.X and the use of at least one antiseizure drug described in the 2015 MarketScan Redbook. Unspecified epilepsy was more common (36.8%) than focal-localized epilepsy (24.6%), generalized convulsive epilepsy (23.8%), generalized nonconvulsive epilepsy (8.9%), other forms of epilepsy (5.2%), infantile spasm (0.3%), and epilepsia partialis continua (0.3%). The high proportion of epilepsy classified as unspecified might be lowered by improved training in epilepsy diagnosis and coding. |
Associations of smoking, physical inactivity, heavy drinking, and obesity with quality-adjusted life expectancy among US adults with depression
Jia H , Zack MM , Gottesman II , Thompson WW . Value Health 2017 21 (3) 364-371 Objectives: To examine associations between four health behaviors (smoking, physical inactivity, heavy alcohol drinking, and obesity) and three health indices (health-related quality of life, life expectancy, and quality-adjusted life expectancy (QALE)) among US adults with depression. Methods: Data were obtained from the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System data. The EuroQol five-dimensional questionnaire (EQ-5D) health preference scores were estimated on the basis of extrapolations from the Centers for Disease Control and Prevention's healthy days measures. Depression scores were estimated using the eight-item Patient Health Questionnaire. Life expectancy estimates were obtained from US life tables, and QALE was estimated from a weighted combination of the EQ-5D scores and the life expectancy estimates. Outcomes were summarized by depression status for the four health behaviors (smoking, physical inactivity, heavy alcohol drinking, and obesity). Results: For depressed adults, current smokers and the physically inactive had significantly lower EQ-5D scores (0.040 and 0.171, respectively), shorter life expectancy (12.9 and 10.8 years, respectively), and substantially less QALE (8.6 and 10.9 years, respectively). For nondepressed adults, estimated effects were similar but smaller. Heavy alcohol drinking among depressed adults, paradoxically, was associated with higher EQ-5D scores but shorter life expectancy. Obesity was strongly associated with lower EQ-5D scores but only weakly associated with shorter life expectancy. Conclusions: Among depressed adults, physical inactivity and smoking were strongly associated with lower EQ-5D scores, life expectancy, and QALE, whereas obesity and heavy drinking were only weakly associated with these indices. These results suggest that reducing physical inactivity and smoking would improve health more among depressed adults. |
National and state estimates of the numbers of adults and children with active epilepsy - United States, 2015
Zack MM , Kobau R . MMWR Morb Mortal Wkly Rep 2017 66 (31) 821-825 Epilepsy, a brain disorder leading to recurring seizures, has garnered increased public health focus because persons with epilepsy experience pronounced and persistent health and socioeconomic disparities despite treatment advances, public awareness programs, and expanded rights for persons with disabilities. For almost all states, epilepsy prevalence estimates do not exist. CDC used national data sources including the 2015 National Health Interview Survey (NHIS) for adults (aged ≥18 years), the 2011-2012 National Survey of Children's Health (NSCH), and the 2015 Current Population Survey data, describing 2014 income levels, to estimate prevalent cases of active epilepsy, overall and by state, to provide information for state public health planning. In 2015, 1.2% of the U.S. population (3.4 million persons: 3 million adults and 470,000 children) reported active epilepsy (self-reported doctor-diagnosed epilepsy and under treatment or with recent seizures within 12 months of interview) or current epilepsy (parent-reported doctor-diagnosed epilepsy and current epilepsy). Estimated numbers of persons with active epilepsy, after accounting for income and age differences by state, ranged from 5,900 in Wyoming to 427,700 in California. NHIS data from 2010-2015 indicate increases in the number of persons with active epilepsy, probably because of population growth. This study provides updated national and modeled state-specific numbers of active epilepsy cases. Public health practitioners, health care providers, policy makers, epilepsy researchers, and other epilepsy stakeholders, including family members and people with epilepsy, can use these findings to ensure that evidence-based programs meet the complex needs of adults and children with epilepsy and reduce the disparities resulting from it. |
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