Mind the Gap: SUDEP in the United States

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Socioeconomic Disparities in SUDEP in the US Cihan E, Hesdorffer DC, Brandsoy M, et al. Neurology. 2020;94(24): e2555-e2566. doi:10.1212/WNL.0000000000009463 Objective: To determine the impact of socioeconomic status (SES) on sudden unexpected death in epilepsy (SUDEP) rates. Methods: We queried all decedents presented for medicolegal investigation at 3 medical examiner offices across the country (New York City, Maryland, San Diego County) in 2009 to 2010 and 2014 to 2015. We identified all decedents for whom epilepsy/seizure was listed as cause/contributor to death or comorbid condition on the death certificate. We then reviewed all available reports. Decedents determined to have SUDEP were included for analysis. We used median income in the ZIP code of residence as a surrogate for SES. For each region, zip code regions were ranked by median household income and divided into quartiles based on total population for 2 time periods. Region-, age-, and income-adjusted epilepsy prevalence were estimated in each zip code. Sudden unexpected death in epilepsy rates in the highest and lowest SES quartiles were evaluated to determine disparity. Examined SUDEP rates in 2 time periods were also compared. Results: There were 159 and 43 SUDEP cases in the lowest and highest SES quartiles. Medical examiner–investigated SUDEP rate ratio between the lowest and highest SES quartiles was 2.6 (95% CI: 1.7-4.1, P <.0001) in 2009 to 2010 and 3.3 (95% CI: 1.9-6.0, P <.0001) in 2014 to 2015. There was a significant decline in overall SUDEP rate between the 2 study periods (36% decrease, 95% CI: 22%-48%, P <.0001). Conclusion: Medical examiner–investigated SUDEP incidence was significantly higher in people with the lowest SES compared to the highest SES. The difference persisted over a 5-year period despite decreased overall SUDEP rates.

Original languageEnglish (US)
Pages (from-to)33-35
Number of pages3
JournalEpilepsy Currents
Issue number1
StatePublished - Jan 2021
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology


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