Epilepsy-related mortality during the COVID-19 pandemic: a nationwide study of routine Scottish data

OBJECTIVE: To examine whether epilepsy-related deaths increased during the COVID-19 pandemic and if the proportion with COVID-19 listed as the underlying cause is different between people experiencing epilepsy-related deaths and those experiencing deaths unrelated to epilepsy. METHODS: This was a Scotland-wide, population-based, cross-sectional study of routinely-collected mortality data pertaining to March–August of 2020 (COVID-19 pandemic peak) compared to the corresponding periods in 2015–2019. ICD-10-coded causes of death of deceased people of any age were obtained from a national mortality registry of death certificates in order to identify those experiencing epilepsy-related deaths (coded G40–41), deaths with COVID-19 listed as a cause (coded U07.1–07.2), and deaths unrelated to epilepsy (death without G40–41 coded). The number of epilepsy-related deaths in 2020 were compared to the mean observed through 2015–2019 on an autoregressive integrated moving average (ARIMA) model (overall, men, women). Proportionate mortality and odds ratios (OR) for deaths with COVID-19 listed as the underlying cause were determined for the epilepsy-related deaths compared to deaths unrelated to epilepsy, reporting 95% confidence intervals (CIs). RESULTS: A mean number of 164 epilepsy-related deaths occurred through March–August of 2015–2019 (of which a mean of 71 were in women and 93 in men). There were subsequently 189 epilepsy-related deaths during the pandemic March–August 2020 (89 women, 100 men). This was 25 more epilepsy-related deaths (18 women, 7 men) compared to the mean through 2015–2019. The increase in women was beyond the mean year-to-year variation seen in 2015–2019. Proportionate mortality with COVID-19 listed as the underlying cause was similar between people experiencing epilepsy-related deaths (21/189, 11.1%, CI 7.0–16.5%) and deaths unrelated to epilepsy (3,879/27,428, 14.1%, CI 13.7–14.6%), OR 0.76 (CI 0.48–1.20). Ten of 18 excess epilepsy-related deaths in women had COVID-19 listed as an additional cause. CONCLUSIONS: There is little evidence to suggest there have been any major increases in epilepsy-related deaths in Scotland during the COVID-19 pandemic. COVID-19 is a common underlying cause of both epilepsy-related and unrelated deaths.