Cause-specific mortality and life years lost in people with epilepsy: a Danish cohort study.

Mortality rates are 2-3 times higher in people with epilepsy than in the general population. This study aimed to quantify how this increased mortality translates into reduced life expectancy and to identify the underlying causes of deaths, thereby offering suggestions for how to reduce mortality associated with epilepsy. In this population-based cohort study, we included all individuals aged 0-94 years who were living in Denmark between 2000 and 2015. Using the nationwide registers, we identified persons diagnosed with epilepsy and estimated the excess of life years lost due to 13 overall and 9 specific causes of death. Among 6,022,160 persons, we identified 129,598 persons with epilepsy (52.6% males), with a mean age of epilepsy onset of 36.5 years (standard deviation = 26.3 years). During the 16 years of follow-up, 851,087 individuals died, and of these 36,923 had been diagnosed with epilepsy. The average reduction in life expectancy in persons with epilepsy was 11.84 years in males (95% confidence interval: 11.66-12.00) and 10.91 years in females (95% confidence interval: 10.70-11.11) compared to the general population. Life expectancy was reduced irrespective of epilepsy etiology (symptomatic approximately 14 years; idiopathic approximately 8-10 years), and in particular in persons with epilepsy and psychiatric comorbidity (approximately 13-16 years). Excess mortality was evident across all causes of death including cardiovascular disorders, accidents, and suicide. People with epilepsy experience a substantial reduction in lifespan that can only partly be explained by underlying conditions. Prevention of epilepsy-related deaths should focus on the consequences of psychiatric comorbidity and on modifiable risk factors associated with preventable causes of death such as accidents, neurological and cardiovascular disorders.