BACKGROUND AND OBJECTIVES Epilepsy is common among older adults, but previous incident studies have had limited ability to make comparisons across key subgroups. We aimed to provide updated epilepsy incidence estimates among older adults, comparing across age, sex, and race/ethnicity. METHODS Using a random sample of 4,999,999 US Medicare beneficiaries older than 65 years, we conducted a retrospective cohort study of epilepsy incidence using administrative claims for 2016-2019. Sampled beneficiaries were enrolled in the Fee-for-Service (FFS) program in each of 2016-2018 and had no epilepsy claims in those years. Non-Hispanic Black and Hispanic beneficiaries were oversampled to ensure adequate cases for detailed comparisons. Incidence in 2019 was identified in the Master Beneficiary Summary File as ≥1 inpatient claim or ≥2 outpatient nondrug claims occurring at least 1 day apart (ICD-10 G40.x). Incidence models were estimated by age, sex, race/ethnicity, and combinations thereof, with adjustment for the racial/ethnic oversampling. RESULTS We identified 20,545 incident epilepsy cases. The overall epilepsy incidence rate (IR) was 393 per 100,000 (99% CI 385-400). Incidence peaked at ages 85-89 (504 [481-529]) and was higher for men (396 [385-407]) than women (376 [366-385]). The sex difference in IRs was constant with age. Incidence was higher for non-Hispanic Black (678 [653-702]) and Hispanic (405 [384-426]), and lower for non-Hispanic Asian/Pacific Islander (272 [239-305]) beneficiaries, compared with non-Hispanic White beneficiaries (354 [299-408]). The age-specific IRs significantly differed by race/ethnicity and sex, but only among non-Hispanic Black beneficiaries-where men had higher rates at younger ages and women at older ages. DISCUSSION We found higher epilepsy IRs among those enrolled in the Medicare FFS system 2016-2019 than previous studies using Medicare claims data from at least a decade ago. The risk of epilepsy onset is higher for those in their late 80s, men, and non-Hispanic Black and Hispanic older adults. There is also evidence that these age-graded risks operate differently for Black men and Black women. Efforts to provide care and services that improve quality of life for older adults living with epilepsy should consider differences by multiple social characteristics simultaneously: age, sex, and race/ethnicity.

中文翻译：

---

2019 年美国医疗保险受益人的癫痫发病率：按年龄、性别和种族/民族划分的差异。


背景和目标 癫痫在老年人中很常见，但之前的事件研究在关键亚组之间进行比较的能力有限。我们的目的是通过对年龄、性别和种族/民族进行比较，提供老年人癫痫发病率的最新估计。方法 我们使用 4,999,999 名 65 岁以上美国医疗保险受益人的随机样本，利用 2016-2019 年的行政索赔对癫痫发病率进行了回顾性队列研究。抽样受益人在 2016 年至 2018 年每年都参加了按服务收费 (FFS) 计划，并且这些年没有提出癫痫索赔。对非西班牙裔黑人和西班牙裔受益人进行了过度抽样，以确保有足够的案例进行详细比较。 2019 年的发病率在主受益人摘要文件中被确定为 ≥1 次住院索赔或 ≥2 次门诊非药物索赔，发生时间间隔至少 1 天 (ICD-10 G40.x)。发病率模型根据年龄、性别、种族/民族及其组合进行估计，并对种族/民族过采样进行调整。结果 我们确定了 20,545 例癫痫病例。总体癫痫发病率 (IR) 为每 100,000 人 393 例 (99% CI 385-400)。发病率在 85-89 岁 (504 [481-529]) 年龄段达到顶峰，男性 (396 [385-407]) 高于女性 (376 [366-385])。 IR 的性别差异随着年龄的增长而保持不变。与非西班牙裔黑人 (678 [653-702]) 和西班牙裔 (405 [384-426]) 受益人相比，非西班牙裔亚裔/太平洋岛民 (272 [239-305]) 受益人的发病率较低。 -西班牙裔白人受益人（354 [299-408]）。特定年龄的 IR 因种族/族裔和性别而存在显着差异，但仅在非西班牙裔黑人受益人中存在差异，其中男性在年轻时的比率较高，而女性在老年时的比率较高。 讨论 我们发现，与之前使用至少十年前的医疗保险索赔数据进行的研究相比，2016-2019 年参加医疗保险 FFS 系统的患者中癫痫 IR 更高。 80 多岁的人、男性、非西班牙裔黑人和西班牙裔老年人患癫痫的风险较高。还有证据表明，这些按年龄分级的风险对黑人男性和黑人女性的影响不同。为改善癫痫老年人的生活质量而提供的护理和服务应同时考虑多种社会特征的差异：年龄、性别和种族/民族。