{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T03:17:20Z","timestamp":1790047040136,"version":"4.0.1"},"reference-count":45,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T00:00:00Z","timestamp":1719014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011959","name":"Institute of Development and Economic Alternatives","doi-asserted-by":"publisher","award":["CIN 13\u2010414"],"award-info":[{"award-number":["CIN 13\u2010414"]}],"id":[{"id":"10.13039\/501100011959","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Epilepsy is associated with significant mortality risk. There is limited research examining how traumatic brain injury (TBI) timing affects mortality in relation to the onset of epilepsy. We aimed to assess the temporal relationship between epilepsy and TBI regarding mortality in a cohort of post\u20109\/11 veterans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study included veterans who received health care in the Defense Health Agency and the Veterans Health Administration between 2000 and 2019. For those diagnosed with epilepsy, the index date was the date of first antiseizure medication or first seizure; we simulated the index date for those without epilepsy. We created the study groups by the index date and first documented TBI: (1) controls (no TBI, no epilepsy), (2) TBI only, (3) epilepsy only, (4) TBI before epilepsy, (5) TBI within 6\u2009months after epilepsy, and (6) TBI &gt;6\u2009months after epilepsy. Kaplan\u2013Meier estimates of all\u2010cause mortality were calculated, and log\u2010rank tests were used to compare unadjusted cumulative mortality rates among groups compared to controls. Cox proportional hazard models were used to compute hazard ratios (HRs) with 95% confidence intervals (CIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 938\u2009890 veterans, 27\u2009436 (2.92%) met epilepsy criteria, and 264\u2009890 (28.22%) had a TBI diagnosis. Mortality was higher for veterans with epilepsy than controls (6.26% vs. 1.12%; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01). Veterans with TBI diagnosed \u22646\u2009months after epilepsy had the highest mortality hazard (HR\u2009=\u20095.02, 95% CI\u2009=\u20094.21\u20135.99) compared to controls, followed by those with TBI before epilepsy (HR\u2009=\u20094.25, 95% CI\u2009=\u20093.89\u20134.58), epilepsy only (HR\u2009=\u20094.00, 95% CI\u2009=\u20093.67\u20134.36), and TBI\u2009&gt;6\u2009months after epilepsy (HR\u2009=\u20092.49, 95% CI\u2009=\u20092.17\u20132.85). These differences were significant across groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>TBI timing relative to epilepsy affects time to mortality; TBI within 6 months after epilepsy or before epilepsy diagnosis was associated with earlier time to death compared to those with epilepsy only or TBI\u2009&gt;6\u2009months after epilepsy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.18026","type":"journal-article","created":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T14:24:31Z","timestamp":1719066271000},"page":"2255-2269","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Mortality among veterans with epilepsy: Temporal significance of traumatic brain injury exposure"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4309-592X","authenticated-orcid":false,"given":"Ali","family":"Roghani","sequence":"first","affiliation":[{"name":"Division of Epidemiology University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen\u2010Pin","family":"Wang","sequence":"additional","affiliation":[{"name":"Glenn Biggs Institute for Alzheimer's &amp; Neurodegenerative Diseases University of Texas Health Science Center at San Antonio  San Antonio Texas USA"},{"name":"Department of Population Health Sciences University of Texas Health Science Center at San Antonio  San Antonio Texas USA"},{"name":"South Texas Veterans Health Care System, Geriatric Research Education &amp; Clinical Center  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Henion","sequence":"additional","affiliation":[{"name":"Division of Epidemiology University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"Informatics, Decision\u2010Enhancement, and Analytic Sciences Center of Innovation Veterans Administration Salt Lake City Health Care System  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Amuan","sequence":"additional","affiliation":[{"name":"Informatics, Decision\u2010Enhancement, and Analytic Sciences Center of Innovation Veterans Administration Salt Lake City Health Care System  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamada","family":"Altalib","sequence":"additional","affiliation":[{"name":"Connecticut Veteran Healthcare System  West Haven Connecticut USA"},{"name":"Department of Neurology Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4901-3852","authenticated-orcid":false,"suffix":"Jr","given":"W. Curt","family":"LaFrance","sequence":"additional","affiliation":[{"name":"Departments of Psychiatry and Neurology Brown University  Providence Rhode Island USA"},{"name":"Department of Psychiatry Providence Veterans Administration Salt Lake City Health Care System Medical Center  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Baca","sequence":"additional","affiliation":[{"name":"Department of Neurology Virginia Commonwealth University  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Van\u00a0Cott","sequence":"additional","affiliation":[{"name":"Veterans Administration Pittsburgh Healthcare System  Pittsburgh Pennsylvania USA"},{"name":"Department of Neurology University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Towne","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Providence Veterans Administration Salt Lake City Health Care System Medical Center  Providence Rhode Island USA"},{"name":"Epilepsy Center of Excellence Central Virginia Veterans Administration Hospital  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Kean","sequence":"additional","affiliation":[{"name":"Division of Health System Innovation and Research, Department of Population Health Sciences University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidney R.","family":"Hinds","sequence":"additional","affiliation":[{"name":"Department of Radiology\/Neurology Uniformed Services University of the Health Sciences  Bethesda Maryland 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