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首页> 外文期刊>JAMA neurology >Association of Levels of Specialized Care With Risk of Premature Mortality in Patients With Epilepsy
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Association of Levels of Specialized Care With Risk of Premature Mortality in Patients With Epilepsy

机译：癫痫患者患者过早死亡率的专业护理水平的关联

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IMPORTANCE Patients with epilepsy are at an elevated risk of premature mortality. Interventions to reduce this risk are crucial. OBJECTIVE To determine if the level of care (non-neurologist, neurologist, or comprehensive epilepsy program) is negatively associated with the risk of premature mortality. design, setting. AND participants In this retrospective open cohort study, all adult patients 18 years or older who met the administrative case definition for incident epilepsy in linked databases (Alberta Health Services administrative health data and the Comprehensive Calgary Epilepsy Programme Registry [CEP]) inclusive of the years 2002 to 2016 were followed up until death or loss to follow-up. The final analyses were performed on May 1,2019. EXPOSURES Evaluation by a non-neurologist, neurologist, or epileptologist. MAIN OUTCOMES AND MEASURES The outcome was all-cause mortality. We used extended Cox models treating exposure to a neurologist or the CEP as time-varying covariates. Age, sex, socioeconomic deprivation, disease severity, and comorbid burden at index date were modeled as fixed-time coefficients. RESULTS A total 23 653 incident cases were identified (annual incidence of 89 per 100 000); the mean age (SD) at index date was 50.8 (19.1) years and 12158 (50.3%) were women. A total of 14 099 (60%) were not exposed to specialist neurological care, 9554 (40%) received care by a neurologist, and 2054 (9%) received care in the CEP. In total, 4098 deaths (71%) occurred in the nonspecialist setting, 1481 (26%) for those seen by a neurologist, and 176 (3%) for those receiving CEP care. The standardized mortality rate was 7.2% for the entire cohort, 9.4% for those receiving nonspecialist care, 5.6% for those seen by a neurologist, and 2.8% for those seen in the CEP. The hazard ratio (HR) of mortality was lower in those receiving neurologist (HR, 0.85; 95% Cl, 0.77-0.93) and CEP (HR, 0.49; 95% Cl, 0.38-0.62) care. In multivariable modeling, specialist care, the age at index, and disease severity were retained in the final model of the association between specialist care and mortality. CONCLUSIONS AND RELEVANCE Exposure to specialist care is associated with incremental reductions in the hazard of premature mortality. Those referred to a comprehensive epilepsy program received the greatest benefit.
机译：癫痫的重要患者处于早产的风险升高。减少这种风险的干预措施至关重要。目的确定护理水平（非神经科医生，神经科医生或综合性癫痫计划）是否与过早死亡率的风险负相关。设计，设置。和参与者在这个回顾性开放的队列研究中，所有成年患者18岁或以上，符合联系数据库中的事件癫痫的行政案例定义（艾伯塔省卫生服务行政卫生数据和全面的Calgary癫痫计划注册表[Cep]）包括多年2002年至2016年被跟进，直到死亡或随访丧失。最终分析于2019年5月1日进行。由非神经科医生，神经科医生或癫痫专家进行风险评估。主要成果和措施结果是全部导致死亡率。我们使用延长的COX模型作为延时的协变量处理暴露于神经科医生或CEP。年龄，性别，社会经济剥夺，疾病严重程度和指数日期的合并负担被建模为固定时系数。结果确定了23个653个入射案件（每100 000的年度发病率为89）;指数日期的平均年龄（SD）为50.8（19.1）岁，12158（50.3％）是妇女。共有14099（60％）未暴露于专业的神经系统护理，9554（40％）通过神经科医生提供护理，2054（9％）在CEP中受到护理。总共有4098人死亡（71％）发生在非专科学家的环境中，1481（26％）为神经科医生，176名（3％）用于接受CEP护理。整个队列的标准化死亡率为7.2％，对于接受非专科医生护理的人，9.4％，神经科医生认为的人5.6％，对于CEP中所见的那些，2.8％。接受神经科学专家（HR，0.85; 95％Cl，0.77-0.93）和Cep（HR，0.49; 95％Cl，0.38-0.62）护理的危险比（HR，0.85; 95％Cl，0.38-0.62）护理中的危险比（HR）较低。在多变量的建模，专业护理，指数年龄和疾病严重程度被保留在专业护理和死亡率之间的结合的最终模型中。结论和相关性暴露于专业护理与过早死亡率危害的增量减少有关。那些提到的综合性癫痫计划得到了最大的好处。

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