评估英国癫痫病社会经济不平等的程度和决定因素:证据的系统回顾和荟萃分析。

IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Public Health Pub Date : 2024-08-01 DOI:10.1016/S2468-2667(24)00132-4
Kathryn J Bush, Emer Cullen, Susanna Mills, Richard F M Chin, Rhys H Thomas, Andrew Kingston, William Owen Pickrell, Sheena E Ramsay
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引用次数: 0

摘要

背景:癫痫发病率及其不良后果方面的社会经济不平等在国际上都有记录,但不平等的程度和影响这种关联的因素在不同国家可能有所不同。英国需要对癫痫采取公共卫生应对措施,在预防癫痫的同时不扩大不平等现象。然而,有关英国癫痫不平等现象的数据尚未进行综述,其根本决定因素也不得而知:在这项系统综述和荟萃分析中,我们检索了六个文献数据库(MEDLINE、Embase、PsycINFO、CINAHL、Web of Science 和 Scopus)以及发表于 1980 年 1 月 1 日至 2024 年 2 月 21 日之间的灰色文献,以确定英国按社会经济因素(个人水平或地区水平)报告癫痫发病率或癫痫相关不良后果的研究。我们纳入了纵向队列研究、使用常规收集的医疗保健数据的研究、横断面研究和匹配队列研究,并排除了会议摘要和未在综述和荟萃分析中报告实证结果的研究。多位审稿人(KJB、EC、SER、WOP 和 RHT)独立筛选研究,KJB 从纳入的研究中提取数据,第二位审稿人(SM 或 EC)检查数据提取情况。我们使用 "批判性评价技能计划 "核对表来评估研究质量。我们采用随机效应荟萃分析法汇集事故率比(IRR),并对不良后果结果进行叙述性综合。本研究已在PROPSPERO(CRD42023394143)上注册:我们通过数据库搜索确定了 2471 项独特的研究。我们纳入了 26 项研究,其中 10 项根据社会经济因素报告了癫痫发病率,16 项报告了与癫痫相关的不良后果。错误分类、参与和解释偏差被认为是研究质量的局限性。元分析表明,社会经济贫困与癫痫发病率之间存在关联,与低贫困组相比,高贫困组(IRR 1-34 [95% CI 1-16-1-56];I2=85%)和中贫困组(IRR 1-23 [95% CI 1-08-1-39];I2=63%)的癫痫发病风险更高。这种关联在仅包括儿童的研究中依然存在(高与低:IRR 1-36 [95% CI 1-19-1-57]; I2=0%)。只有两项研究探讨了影响癫痫发病率的因素。有关英国不良后果不平等的证据有限:在英国,癫痫发病率的社会经济不平等现象十分明显。为制定以证据为基础的癫痫公共卫生对策,需要开展进一步研究,以了解受影响人群、决定相关性的因素以及不良后果的不平等程度:英国癫痫研究所。
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Assessing the extent and determinants of socioeconomic inequalities in epilepsy in the UK: a systematic review and meta-analysis of evidence.

Background: Socioeconomic inequalities in epilepsy incidence and its adverse outcomes are documented internationally, yet the extent of inequalities and factors influencing the association can differ between countries. A UK public health response to epilepsy, which prevents epilepsy without widening inequalities, is required. However, the data on UK epilepsy inequalities have not been synthesised in a review and the underlying determinants are unknown.

Methods: In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143).

Findings: We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16-1·56]; I2=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I2=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19-1·57]; I2=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes.

Interpretation: Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes.

Funding: Epilepsy Research Institute UK.

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来源期刊
Lancet Public Health
Lancet Public Health Medicine-Public Health, Environmental and Occupational Health
CiteScore
55.60
自引率
0.80%
发文量
305
审稿时长
8 weeks
期刊介绍: The Lancet Public Health is committed to tackling the most pressing issues across all aspects of public health. We have a strong commitment to using science to improve health equity and social justice. In line with the values and vision of The Lancet, we take a broad and inclusive approach to public health and are interested in interdisciplinary research. We publish a range of content types that can advance public health policies and outcomes. These include Articles, Review, Comment, and Correspondence. Learn more about the types of papers we publish.
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