Working years lost in people with epilepsy according to underlying aetiology: a population-based cohort study

We quantify the loss of working years for people with epilepsy according to underlying aetiology and compare to the general population.

This population-based cohort study included all individuals aged 18-65 years living in Denmark from 1995 to 2018. Using nationwide registers from 1977 onward, we identified people with epilepsy and grouped them by presumed aetiology (secondary: infection, perinatal insult, congenital malformation, brain tumour, traumatic brain injury, stroke or unknown) and obtained annual data on primary income source during 1995-2020. The main outcome was working years lost comparing people with epilepsy to the general population, reflecting losses of working life from permanent (death, disability pension, early retirement) and temporary (unemployment, sick leave) factors.

The study included 5 466 144 individuals, with 48 223 (0.9%) having epilepsy of unknown aetiology and 26 754 (0.5%) with secondary epilepsy. Compared with the general population, post-traumatic epilepsy was associated with the greatest average loss of working life (10.2 years, 95% CI 9.9 to 10.4), whereas brain tumour-related epilepsy was associated with a reduction of 9.1 years (95% CI 8.8 to 9.4) and post-stroke epilepsy with a reduction of 6.6 years (95% CI 6.4 to 6.8). Epilepsy of unknown aetiology was associated with a 5.4-year loss (95% CI 5.2 to 5.5). Across all epilepsy types, most reductions in working life resulted from higher rates of disability pension and premature death.

Epilepsy, especially when secondary to an underlying brain insult, was associated with significant loss of working life from both disability and premature death. More support is needed to help people with epilepsy secure and retain employment.