Objective We aimed to describe epilepsy incidence, prevalence, mortality and risk factors for death in epilepsy.

Methods A cohort study in the UK General Practice Research Database (GPRD) over the period 1993 to 2007. Subjects were ever diagnosed with epilepsy and prescribed anticonvulsant drugs. We described changes in the incidence, prevalence and mortality of epilepsy. A nested case-control study compared subjects with epilepsy who died with those who did not.

Results The prevalence of epilepsy increased from 9 per 1000 in 1993 to 12 per 1000 in 2007. Mortality from all-causes in persons diagnosed with epilepsy increased from 21 to 25 per 100 000 in women and declined before increasing in men. In a nested case control study, mortality was associated with alcohol problems (odds ratio 2.93, 95% CI 2.22 to 3.86, p<0.001), having collected the last anticonvulsant prescription between 90 and 182 days previously (1.83, CI 1.66 to 2.03, p<0.001), having an injury in the last year (1.41, CI 1.30 to 1.53, p<0.001) and treated depression (1.39, CI 1.28 to 1.50, p<0.001). In data available from 2004 onwards, being recorded seizure free in the last 12 months was associated with lower mortality (0.78, CI 0.71 to 0.86, p<0.001).

Conclusions Patients who have alcohol problems, do not collect repeat prescriptions for anticonvulsant drugs, have recent injuries, or treated depression, may be at increased risk of death. Patients who remain seizure free over 12 months are at lower risk.