Excess mortality and causes of death of people with epilepsy in rural China: A nationwide cohort study.

OBJECTIVE: Epilepsy is associated with increased risk of excess mortality compared to the general population. Identifying causes of death is critical for guiding prevention strategies. Earlier studies in resource-limited settings suggested that accidental deaths were the main causes, but whether the mortality pattern has changed over time remains unclear. This study aimed to update the knowledge on mortality and causes of death of people with epilepsy in rural China. METHODS: In this nationwide cohort study, we analyzed data from the Epilepsy Prevention and Management Project in rural China between January 1, 2018, and December 31, 2020. Mortality outcomes included all-cause mortality, causes of death, and standardized mortality ratios (SMRs). Kaplan-Meier, multivariable Cox, and restricted cubic spline analyses were used to assess mortality risk and associated factors. RESULTS: Among 17 515 participants followed for 25 922 person-years, 381 deaths were recorded, yielding an all-cause mortality rate of 14.7 per 1000 person-years. The leading causes of death were circulatory system diseases (47.8%), including cerebrovascular disease (28.9%), and heart disease (18.9%). The all-cause SMR was 3.51 (95% confidence interval = 3.33-3.70). The highest cause-specific excess mortality was observed for brain malignancies (SMR = 20.30). Male sex, older age at epilepsy onset, longer disease duration, and higher baseline seizure frequency were independently associated with mortality. SIGNIFICANCE: People with epilepsy in rural China continue to experience substantial and potentially preventable excess mortality. As mortality patterns shift, prevention strategies should extend beyond seizure control and injury prevention to include vascular risk management and timely neuroimaging for suspected structural lesions. Prospective studies are needed to determine whether these strategies improve survival.