Highlights
- •Adult diagnosis of epilepsy was associated with an increased risk of subsequent substance use disorder diagnosis.
- •A migraine diagnosis was associated with an increased risk of substance use disorder but not to the same extent as an epilepsy diagnosis.
- •Adults diagnosed with epilepsy who were uninsured or insured through Medicaid had a higher incidence of substance use disorder diagnoses.
- •Adults with epilepsy may benefit from mental healthcare inclusive of substance use prevention.
Abstract
Objective
We investigated adult-onset epilepsy as a risk factor for the development of substance
use disorder (SUD) by comparing the rate of SUD diagnosis among adults diagnosed with
epilepsy with presumably healthy controls with lower extremity fractures (LEF). For
additional comparison, we investigated the risk for adults with migraine only. Epilepsy
and migraine are both episodic neurological disorders and migraine is frequently comorbid
with epilepsy.
Methods
We conducted a time-to-event analysis using a subset of surveillance data of hospital
admissions, emergency department visits, and outpatient visits in South Carolina,
USA from January 1, 2000, through December 31, 2011. Individuals aged 18 years or
older were identified using the International Classification of Disease, 9th Revision Clinical Modification (ICD-9) with a diagnosis of epilepsy (n = 78,547; 52.7% female, mean age 51.3 years), migraine (n = 121,155; 81.5% female, mean age 40.0 years), or LEF (n = 73,911; 55.4% female, mean age 48.7 years). Individuals with SUD diagnosis following
epilepsy, migraine, or LEF were identified with ICD-9 codes. We used Cox proportional
hazards regression to model the time to SUD diagnosis comparing adults diagnosed with
epilepsy, migraine, and LEF, adjusting for insurance payer, age, sex, race/ethnicity,
and prior mental health comorbidities.
Results
Compared to LEF controls, adults with epilepsy were diagnosed with SUD at 2.5 times
the rate [HR 2.48 (2.37, 2.60)] and adults with migraine only were diagnosed with
SUD at 1.12 times the rate [HR 1.12 (1.06, 1.18)]. We found an interaction between
disease diagnosis and insurance payer, with hazard ratios comparing epilepsy to LEF
of 4.59, 3.48, 1.97, and 1.44 within the commercial payer, uninsured, Medicaid, and
Medicare strata, respectively.
Significance
Compared to presumably healthy controls, adults with epilepsy had a substantially
higher hazard of SUD, while adults with migraine only showed a small, but significant,
increased hazard of SUD.
Keywords
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Article info
Publication history
Published online: May 18, 2023
Accepted:
May 7,
2023
Received in revised form:
April 26,
2023
Received:
February 16,
2023
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
