Prevalence and patterns of comorbidities in individuals with epilepsy: A nationwide analysis using colombian healthcare registry data

Introduction: Epilepsy is a multifaceted neurological disorder that extends beyond seizure episodes, with substantial comorbidities impacting patients' quality of life. This study quantifies the burden and association patterns of epilepsy-related comorbidities in the Colombian population. Methods: This descriptive, cross-sectional study analyzed data from the nationwide Colombian healthcare registry (RIPS) from 2019 to 2023. We estimated the prevalence of epilepsy and selected comorbidities including neurological conditions (migraine, multiple sclerosis, stroke, Alzheimer's disease in individuals 65+), psychiatric disorders (depression, major depression, anxiety, schizophrenia), trauma (general and head trauma), and infectious diseases (HIV, neurocysticercosis). Prevalence ratios (PRs) were calculated comparing individuals with epilepsy to those without, with stratification by sex and age groups. Chi-squared tests were conducted to assess statistical significance of differences in prevalence, with p < 0.05 considered significant. Results: Among 53,785,138 individuals in the Colombian healthcare system, 461,118 were diagnosed with epilepsy (prevalence 8.57 per 1000), with the highest prevalence in older adults (11.37 per 1000 in ages 65+). Neurological comorbidities were common, with migraine present in 6.86 % of epilepsy patients versus 3.89 % in the general population (p < 0.001), multiple sclerosis in 0.152 % versus 0.021 % (p < 0.001), and stroke in 6.04 % versus 0.75 % (p < 0.001). Among psychiatric conditions, depression affected 5.84 % of epilepsy patients compared to 1.87 % in the general population (p < 0.001), while schizophrenia was diagnosed in 4.13 % of epilepsy patients versus 0.41 % in the general population (p < 0.001). Trauma was present in 25.0 % of epilepsy patients compared to 16.4 % generally (p < 0.001), with head trauma specifically in 7.1 % versus 2.5 % (p < 0.001). Neurocysticercosis, though rare overall (0.0064 % in general population), was notably more prevalent in epilepsy patients (0.289 %, p < 0.001). Significant sex differences were observed, with females showing higher prevalence of migraine (9.82 % vs 3.89 % in males) and depression (7.33 % vs 4.34 %) within the epilepsy population, while males had higher rates of schizophrenia (4.81 % vs 3.46 %) and head trauma (8.93 % vs 5.32 %). Conclusion: This study provides critical insights into the burden of epilepsy-related comorbidities in Colombia, highlighting the importance of targeted interventions. The substantial comorbidity burden demonstrated across neurological, psychiatric, traumatic, and infectious domains underscores the importance of interdisciplinary, patient-centered care approaches that extend beyond seizure control. By addressing these comorbidities through integrated care models, clinicians can significantly improve both health outcomes and quality of life for people living with epilepsy.