Evolving Mortality Trends and Disparities Among Older Adults with Coexisting Seizures and Cardiovascular Disease: A 25-year National Analysis
Rawdah Shakil1, Mushtaq Ahmad2, Hamza Ehtesham2, Shahzaib Khan3, Muaz Ahmed4, Muhammad Sohaib5, Marium Mirza2
1Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan., 2Ziauddin University, Karachi, Pakistan, 3Rutgers Health Community Medical Center, New Jersey, United States of America., 4Akhtar Saeed Medical & Dental College, Lahore, Pakistan, 5Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
Objective:
This study examines seizure- and cardiovascular disease (CVD)-related trends and demographics, as their co-existence remains understudied.
Background:
Seizures stress the cardiovascular system which increases their risk of cardiovascular events and mortality.
Design/Methods:
Death certificates from the CDC WONDER database (1999–2023) were analyzed to assess seizure- and CVD-related mortality among adults aged ≥65 years. CVD included ischemic heart disease (IHD), arrhythmias, and heart failure (HF). Age-adjusted mortality rates (AAMRs) per 100,000 (95% CIs), annual percentage change (APC) and its average (AAPC) were calculated.
Results:
Out of 117,933 seizure- and CVD-related deaths, IHD led, followed by arrhythmias and HF. Most deaths occurred in medical facilities (40.3%) and nursing homes (32.4%). The highest AAMR was seen among seizure patients with arrhythmias (6.1), followed by IHD (6.0) and HF (4.2). Seizure and CVD-related mortality initially declined from 1999 to 2008 (APC: -4.8; 95% CI: -5.8 to -3.7), remained stable for a period, and then increased from 2016 to 2023 (APC: 6.0; 95% CI: 4.6 to 7.3). By CVD subtype, mortality among seizure patients with IHD decreased (AAPC: -2.2; 95% CI: -3.1 to -1.3), while mortality increased in patients with seizures and arrhythmias (AAPC: 2.2; 95% CI: 1.0 to 3.4). The AAMRs for seizure and HF patients remained similar throughout (AAPC: -0.2; 95% CI: -1.2 to 0.8). Overall, males (12.1) had higher AAMRs than females (9.6). NH Black adults had the highest rate (20.0), followed by NH White (10.3) and Hispanics (8.0). Regional AAMRs were similar (10.2 to 11.2). State-wise, AAMR was highest in District of Columbia (19.4) and lowest in Arizona (5.6)
Conclusions:
Seizure- and CVD-related mortality initially declined but rose again after 2016, with arrhythmia-related deaths increasing steadily. Disparities were noted among males and NH Blacks. These results highlight the need for improved management and targeted interventions.
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