Abstract / Summary
Purpose This nationwide, population-based study aimed to assess the demographic and socioeconomic impact of epilepsy in Sweden during the era of newer anti-seizure medications (ASMs). By examining prescription patterns and socioeconomic disparities, the study sought to identify vulnerable subgroups and to encourage the development of strategies for equitable access to effective therapies. Methods A retrospective observational cohort study was conducted using linked national registers, including the National Patient Register, National Prescribed Drug Register, Cause of Death Register, Population Register, and LISA database. All adults with at least one epilepsy-related healthcare visit between 2015 and 2022 were included, matched to controls by birth year, sex, and municipality. Sub-cohorts were defined by prescribed ASM type (newer vs. older). Socioeconomic and clinical variables were analysed using descriptive statistics and logistic regression. Results The cohort comprised 96,013 persons with epilepsy and 287,952 controls. Individuals with epilepsy had significantly lower education, income, and employment rates, and higher odds of comorbidities and mortality compared to controls. Patients treated with newer ASMs were younger, more often female, and had higher odds of comorbidities and lower socioeconomic status than those on older therapies. Regional variation in access to newer ASMs exceeded fourfold and persisted after adjustment for socioeconomic and demographic factors. Conclusion Epilepsy in Sweden is associated with persistent socioeconomic disadvantages, elevated comorbidity burden, and increased mortality. Access to newer ASMs remains inequitable, driven by regional prescribing practices rather than patient characteristics. Continued efforts are needed to ensure equitable, evidence-based care and improved treatment access for this vulnerable population.