Nierówności społeczno-gospodarcze i przestrzenne a śmiertelność związana z epilepsją w Peru: ogólnokrajowe badanie ekologiczne z lat 2017-2023
Socioeconomic deprivation and spatial inequalities in epilepsy-related mortality in Peru: A national ecological study, 2017-2023
W skrócie
Badacze przeanalizowali 4547 zgonów związanych z epilepsją w Peru w latach 2017-2023 i odkryli, że śmiertelność z powodu epilepsji jest znacznie wyższa w najbiedniejszych i najbardziej wiejskich regionach kraju. Na każdy 100 tysięcy mieszkańców umierało 1,73 osób w najbogatszych obszarach, a 2,98 w najbiedniejszych. Wyniki pokazują, że dostęp do opieki zdrowotnej i warunki życia mają ogromny wpływ na przeżywalność pacjentów z epilepsją.
Oryginalny abstract (angielski)
INTRODUCTION: Epilepsy-related mortality may reflect socioeconomic and territorial inequalities, as well as disparities in access to healthcare. Subnational evidence from Latin America remains limited. OBJECTIVE: To evaluate socioeconomic and spatial inequalities in epilepsy-related mortality across provinces in Peru. METHODS: A national ecological study using SINADEF data from 2017 to 2023 was conducted. Epilepsy-related mortality was defined as any mention of ICD-10 codes G40-G41. Provincial deprivation combined poverty, rurality, and low educational attainment using principal component analysis. Official annual provincial population denominators, age-standardized rates, the slope index of inequality (SII), relative index of inequality (RII), negative binomial regression, and a Bayesian BYM2 model were used. Code-specific negative-binomial sensitivity analyses evaluated G40 and G41 separately. RESULTS: A total of 4547 deaths across 196 provinces were analyzed. The age-standardized mortality rate was 1.99 per 100,000 person-years and increased from 1.73 in the least deprived quintile to 2.98 in the most deprived quintile (Q5/Q1 =1.73). The RII was 1.81 (95% CI 1.34-2.45), and the SII was + 1.27 per 100,000 person-years (95% CI 0.64-1.91). In the BYM2 model, each 1-SD increase in deprivation was associated with 18% higher mortality (RR 1.18; 95% CrI 1.10-1.27; P[RR>1]=1.00). G40 was mentioned in 4196 deaths and G41 in 507; 156 certificates contained both. In code-specific sensitivity models, the deprivation association persisted for G40 (RR 1.19; 95% CI 1.11-1.27) and G41 (RR 1.34; 95% CI 1.20-1.49). The socioeconomic gradient persisted over time. CONCLUSIONS: Epilepsy-related mortality showed a persistent socioeconomic and spatial gradient. Rurality was the most robust individual component, supporting the evaluation of territorial barriers to healthcare.