Racial/ethnic differences in the association of incident stroke with late onset epilepsy: The Northern Manhattan Study

Epilepsia. 2024 Dec;65(12):3561-3570. doi: 10.1111/epi.18156. Epub 2024 Oct 15.

Abstract

Objective: Little is known about the incidence of late onset epilepsy (LOE) across different racial/ethnic groups in the USA, particularly in the Hispanic population. Stroke, a strong predictor of LOE, is more common in non-Hispanic Blacks (NHBs) and Hispanics than in non-Hispanic Whites (NHWs). We assessed the incidence of LOE across racial/ethnic groups and examined whether the associations of stroke with LOE risk differ by race/ethnicity.

Methods: The Northern Manhattan Study is a population-based longitudinal study of older adults enrolled between 1993 and 2001. Participants free of history of stroke or epilepsy at baseline (n = 3419) were followed prospectively for incidence of LOE. We estimated LOE incidence per 1000 person-years in each racial/ethnic group. We used Cox proportional hazards regression to assess the association of race/ethnicity with LOE and multiplicative interactions of race/ethnicity with incident stroke in relation to LOE, adjusting for demographics and comorbid diagnoses.

Results: During 51 176 person-years of follow-up, 183 individuals developed LOE. Incidence of LOE was significantly higher in NHBs (6.2 per 1000 person-years) than in NHWs (3.3 per 1000 person-years, p = .004). There was no significant difference in LOE incidence between NHWs (3.3 per 1000 person-years) and Hispanics (2.6 per 1000 person-years, p = .875). However, following incident stroke, the risk of LOE differed across racial/ethnic groups. Incident stroke was associated with 2.55 times the risk of LOE among NHWs (95% confidence interval [CI] = .88-7.35), 8.53 times the risk of LOE among Hispanics (95% CI = 5.36-13.57, p = .04 for stronger association than that in NHWs), and 6.46 times the risk of LOE among NHBs (95% CI = 3.79-11.01, p = .12 for stronger association than that in NHWs).

Significance: We found a stronger association of incident stroke with LOE risk in Hispanics and NHBs than in NHWs, offering some insight into the racial/ethnic disparities of LOE incidence.

Keywords: incident stroke; late onset epilepsy; racial/ethnic differences.

MeSH terms

  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Black or African American / statistics & numerical data
  • Epilepsy* / epidemiology
  • Epilepsy* / ethnology
  • Female
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • New York City / epidemiology
  • Prospective Studies
  • Risk Factors
  • Stroke* / epidemiology
  • Stroke* / ethnology
  • White / statistics & numerical data