{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T02:35:34Z","timestamp":1780626934254,"version":"3.54.1"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T00:00:00Z","timestamp":1730505600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T00:00:00Z","timestamp":1730505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000090","name":"Congressionally Directed Medical Research Programs","doi-asserted-by":"publisher","award":["W81XWH\u201018\u20101\u20100247"],"award-info":[{"award-number":["W81XWH\u201018\u20101\u20100247"]}],"id":[{"id":"10.13039\/100000090","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["1IK6HX003762"],"award-info":[{"award-number":["1IK6HX003762"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate phenotypes of comorbidity before and after an epilepsy diagnosis in a national cohort of post\u20109\/11 Service Members and Veterans and explore phenotypic associations with mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Among a longitudinal cohort of Service Members and Veterans receiving care in the Veterans Health Administration (VHA) from 2002 to 2018, annual diagnoses for 26 conditions associated with epilepsy were collected over 5\u2009years, ranging from 2\u2009years prior to 2\u2009years after the year of first epilepsy diagnosis. Latent class analysis (LCA) was used to identify probabilistic comorbidity phenotypes with distinct health trajectories. Descriptive statistics were used to describe the characteristics of each phenotype. Fine and Gray cause\u2010specific survival models were used to measure mortality outcomes for each phenotype up to 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six distinct phenotypes were identified: (1) relatively healthy, (2) post\u2010traumatic stress disorder, (3) anxiety and depression, (4) chronic disease, (5) bipolar\/substance use disorder, and (6) polytrauma. Accidents were the most common cause of death overall, followed by suicide\/mental health and cancer, respectively. Each phenotype exhibited unique associations with mortality and cause of death, highlighting the differential impact of comorbidity patterns on patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>By delineating clinically meaningful epilepsy comorbidity phenotypes, this study offers a framework for clinicians to tailor interventions. Moreover, these data support systems of care that facilitate treatment of epilepsy and comorbidities within an interdisciplinary health team that allows continuity of care. Targeting treatment toward patients with epilepsy who present with specific heightened risks could help mitigate adverse outcomes and enhance overall patient care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.18170","type":"journal-article","created":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T15:09:05Z","timestamp":1730560145000},"page":"170-183","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Distinct comorbidity phenotypes among post\u20109\/11 Veterans with epilepsy are linked to diverging outcomes and mortality risks"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4196-7763","authenticated-orcid":false,"given":"Mary Jo","family":"Pugh","sequence":"first","affiliation":[{"name":"Informatics, Decision Enhancement, &amp; Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Division of Epidemiology, Department of Internal Medicine University of Utah Health Science Center, University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9889-8351","authenticated-orcid":false,"given":"Heidi","family":"Munger Clary","sequence":"additional","affiliation":[{"name":"Department of Neurology Wake Forest University School of Medicine  Winston Salem North Carolina USA"},{"name":"W.G. \u201cBill\u201d Hefner VA Medical Center  Salisbury North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Myers","sequence":"additional","affiliation":[{"name":"Informatics, Decision Enhancement, &amp; Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Division of Epidemiology, Department of Internal Medicine University of Utah Health Science Center, University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eamonn","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Informatics, Decision Enhancement, &amp; Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Division of Epidemiology, Department of Internal Medicine University of Utah Health Science Center, University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Amuan","sequence":"additional","affiliation":[{"name":"Informatics, Decision Enhancement, &amp; Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia A.","family":"Swan","sequence":"additional","affiliation":[{"name":"Polytrauma Rehabilitation Center South Texas Veterans Health Care System  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2231-6770","authenticated-orcid":false,"given":"Sidney","family":"Hinds","sequence":"additional","affiliation":[{"name":"Department of Neurology\/Radiology Uniformed Services University of the Health Services  Bethesda Maryland USA"},{"name":"SCS Consulting LLC  Winsted Connecticut USA"},{"name":"Major League Soccer Players Association  Bethesda Maryland USA"},{"name":"Division of Neuropsychiatry and Behavioral Neurology, Department of Psychiatry Rhode Island Hospital  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4901-3852","authenticated-orcid":false,"given":"W. Curt","family":"LaFrance","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurology Brown University  Providence Rhode Island USA"},{"name":"Department of Psychiatry and Neurology Providence VA Medical Center  Providence Rhode Island USA"},{"name":"Department of Neurology VA Connecticut Health Care System  West Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamada","family":"Altalib","sequence":"additional","affiliation":[{"name":"Department of Neurology and Psychiatry, Yale School of Medicine Yale University  New Haven Connecticut USA"},{"name":"Department of Neurology Virginia Commonwealth University School of Medicine, Virginia Commonwealth University  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Towne","sequence":"additional","affiliation":[{"name":"Department of Neurology Virginia Commonwealth University School of Medicine, Virginia Commonwealth University  Richmond Virginia USA"},{"name":"Department of Neurology Richmond Veterans Affairs Medical Center  Richmond Virginia USA"},{"name":"Epilepsy Center of Excellence Central Virginia Veterans Administration Hospital  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Henion","sequence":"additional","affiliation":[{"name":"Informatics, Decision Enhancement, &amp; Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Division of Epidemiology, Department of Internal Medicine University of Utah Health Science Center, University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"White","sequence":"additional","affiliation":[{"name":"Informatics, Decision Enhancement, &amp; Analytic Sciences (IDEAS) Center VA Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Division of Epidemiology, Department of Internal 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