Abstracts

Rationale: Comorbidities are common in epilepsy. We examined the burden of comorbidity using the Elixhauser Index using medical records and patient or parent interview to determine whether these differ in people with incident epilepsy and first unprovoked seizure in the diverse disadvantaged communities of Harlem and Northern Manhattan. Methods: We enrolled people with first unprovoked sizure and incident epilepsy in the communities of Harlem and Northern Manhattan ascertained in hospital emergency departments, clinics and epilepsy monitoring units in several hospitals in and outside of these communities. Using the Elixhauser Index with a few additional items, we compared patient or parent report of comorbidities in subgroups and also assessed the reliability of patient or parent report and hospital medical records in the 137 participants who agreed to be interviewed and had data entered in the database. The Elixhauser Index was assessesed at enrollment. Means were compared using t-tests. The Kappa statistic was calculated to determine the agreement beyond chance between the interview and the medical record for 16 comorbidities identified as present and having a prevalence of 4% or greater. Results: The demographics of the participants are shown in Table 1. Approximately 40% had at least one or two comorbidities, regardless of the source. The mean number of comorbidities was 1.6 (SD 1.8) for the interview and 1.9 (SD 2.1) for medical records. The mean number of comorbidities was 2.1 in medical records of 53 participants with incident epilepsy compared to 1.7 in 84 participants with a first unprovoked seizure (ns). The mean number of comorbidities differed by age for the interview (mean in children 0.8 vs 2.3 in adults, p<0.001); similar results were seen for comorbidities assessed in the medical records. Kappa was excellent for 5 disorders, fair to good for 8 disorders, and poor for 4 disorders (Table 2), all of which had a prevalence of at least 4%. Conclusions: Overall, there was at least fair to good agreement for 75% of the 16 disorders on the Elixhauser Index highlighted here when comorbidities ascertained through interview were compared to those ascertained in the medical record. This suggests that in studies without medical records, interviews using the Elixhauser Index may be a reasonable substitute.