Electrocardiogram Abnormalities and Associated Factors Among People with and without Epilepsy Attending the Outpatient Department at Referral Hospitals in Amhara Regional State, Northern Ethiopia, 2022: Institutional-Based Comparative Cross-Sectional Study

Figures & data

Table 1 Sociodemographic Status of Epileptic and Non-Epileptic Groups in ARS Referral Hospitals, Ethiopia, 2022

Variables	Categories	Group Frequency, N (%)		P value
		Epileptic	Non-Epileptic
Age, median (IQR)		28 (11)	25 (8)	0.35
Marital status	Married	154 (38.2)	184 (46.7)	0.39
	Unmarried	207 (51.4)	189 (46.9)
	Divorced	30 (7.4)	21 (5.2)
	Widowed	12 (3.0)	9 (2.2)
Residence	Urban	81 (20.1)	77 (19.1)	0.80
	Rural	322 (79.9)	326 (80.9)
Income, median (IQR)		2000 (2000)	2000 (1400)	0.94
Educational status	Unable to read/ write	97 (24.1)	95 (23.6)	0.10
	≤Grade 8	98 (24.3)	85 (21.1)
	Grade 9–12	125 (31.0)	113 (28.0)
	Diploma or above	83 (20.6)	110 (27.3)
Occupation	Farmer	119 (29.5)	125 (31.0)	0.47
	Student	121 (30.0)	115 (28.5)
	Government employee	39 (9.7)	46 (11.4)
	Merchant	20 (5.0)	30 (7.5)
	Daily labourer	42 (10.4)	31 (7.7)
	House wife	12 (3.0)	12 (3.0)
	Private employee	29 (7.2)	25 (6.2)
	Other	21 (5.2)	19 (4.7)

Note: Other (pensioner, prisoner, driver).

Abbreviation: IQR, interquartile range.

Table 2 Comparison of Behavioural Factors Between Epileptic and Non-Epileptic Subjects in ARS, Ethiopia, 2022

Variable	Category	Group, Total (%)		P value
		Epileptic	Non-Epileptic
Smoking	Never	371 (92.1)	383 (95.1)	0.01*
	Former/current	32 (7.9)	20 (4.9)
Chat chewing	Never	336 (83.4)	351 (87.1)	0.047*
	Ever/current	67 (16.6)	52 (12.9)
Alcohol drinking	Abstainer	30 (7.4)	34 (8.5)	0.26
	Moderate	274 (68.0)	288 (71.5)
	Frequent	99 (24.6)	81 (20.0)
Physical activity	Adequate	142 (35.2)	161 (40.0)	0.47
	Inadequate	261 (64.8)	242 (60.0)

Note: *P value ≤0.05.

Table 3 Clinical Profile of Non-Epileptic and Epileptic Patients at ARS Referral Hospitals, Ethiopia, 2022

Variable	Category	Total (%)	ECG Abnormality		X^2/ Wilcoxon (P value)
			Yes in %	No in %
Epileptic group
Hypertension	Yes	34 (8.4)	58.8	41.2	0.002*
	No	369 (91.6)	32.5	67.5
BMI	Underweight	12 (3.0)	50.0	50.0	0.003*
	Normal	361 (89.6)	33.1	66.9
	Overweight/ obese	30 (7.4)	56.7	43.3
Duration of epilepsy, median ±IQR (years)		9±7	10±7	8±6	0.013*
Epilepsy control	Controlled	286 (81.0)	31.0	69.0	<0.001*
	Uncontrolled	117 (29.0)	62.1	31.9
Type of AED	Carbamazepine	66 (16.4)	43.2	56.8	0.735
	Phenobarbital	73 (18.1)	42.9	57.1
	Others	18 (4.5)	34.6	65.4
	Combined	246 (61.0)	40.3	59.7
PDD to DDD ratio	<One	280 (69.5)	38.9	61.1	0.245
	One	123 (30.5)	43.3	56.7
Seizure within 3 months	None	336 (83.3)	37.5	62.5	0.005*
	One	39 (9.7)	44.7	55.3
	>One	28 (7.0)	52.4	47.6
Non-epileptic group
Hypertension	Yes	30 (7.4)	50.7	49.3	0.03*
	No	373 (92.6)	31.9	68.1
BMI	Underweight	8 (2.0)	25	75	0.01*
	Normal	357 (88.6)	35.1	64.9
	Overweight/ obese	38 (9.4)	56.9	42.1

Note: *P value ≤0.05.

Abbreviations: IQR, interquartile range; BMI, body mass index; AED, anti-epileptic drug; PDD, prescribed daily dose; DDD, defined daily dose.

Table 4 Patterns of ECG Abnormality Among the Epileptic and the Non-Epileptic Group in ARS Referral Hospitals, Ethiopia, 2022

Variable	Category	Total Number (%)	Groups in Number (%)		P value
			Epileptic	Non-Epileptic
ECG abnormality	Yes	278 (34.5)	161 (40.0)	117 (29.0)	0.022*
	No	528 (65.5)	242 (60.0)	286 (71.0)
Heart rate	Normal	734 (91.1)	361 (89.6)	373 (92.6)	0.295
	Abnormal	72 (8.9)	42 (10.4)	30 (7.4)
P wave	Normal	786 (97.5)	394 (97.8)	392 (97.3)	0.461
	Abnormal	20 (2.5)	9 (2.2)	11 (2.7)
PR interval	Normal	787 (97.6)	391 (97)	396 (98.3)	0.053
	Abnormal	19 (2.4)	12 (3.0)	7 (1.7)
QRS wave	Normal	781 (96.9)	388 (96.3)	393 (97.5)	0.398
	Abnormal	25 (3.1)	15 (3.7)	10 (2.5)
QTc interval	Normal	786 (97.5)	389 (96.5)	397 (98.5)	0.042
	Abnormal	20 (2.5)	14 (3.5)	6 (1.5)
BBB (R/L)	Yes	38 (4.7)	30 (7.4)	8 (2.0)	0.01*
	No	768 (95.3)	373 (92.6)	395 (98.0)
Axis deviation	Yes	78 (9.7)	42 (10.4)	36 (8.9)	0.613
	No	728 (90.3)	361 (89.6)	367 (91.1)
Right/left atrial hypertrophy	Yes	24 (3.0)	10 (2.5)	14 (3.5)	0.703
	No	782 (97.0)	393 (97.5)	389 (96.5)
Right ventricular hypertrophy	Yes	20 (2.5)	12 (3.0)	8 (2.0)	0.522
	No	786 (97.5)	391 (97.0)	395 (98.0)
Left ventricular hypertrophy	Yes	31 (3.8)	14 (3.5)	17 (4.0)	0.610
	No	775 (96.2)	389 (96.5)	386 (96.0)
Abnormal Q wave	Yes	46 (5.7)	36 (8.9)	10 (2.5)	0.005*
	No	760 (94.3)	367 (91.1)	393 (97.5)
Abnormal T wave	Yes	28 (3.5)	20 (5.0)	8 (2.0)	0.103
	No	778 (96.5)	383 (95.0)	395 (98.0)
Abnormal ST segment	Yes	19 (2.4)	14 (3.5)	5 (1.2)	0.040
	No	787 (97.6)	389 (96.5)	398 (98.8)

Notes: *P value ≤0.05.

Abbreviation: BBB (R/L), right and/or left bundle branch block.

Table 5 Factors Associated with ECG Abnormality Among Non-Epileptic and Epileptic Patients in ARS Referral Hospitals, Ethiopia, 2022

Variables	ECG Abnormality (N = 806)		COR (95% CI)	AOR (95% CI)
	Yes	No
Age (median ± IQR)	27 ± 9	26 ± 9	2.01 (0.76–3.24)	1.95 (0.74–3.02)
Residence
Urban	56	102	1	1
Rural	222	426	0.95 (0.22–1.340)	0.38 (0.18–1.04)
Marital status
Married	110	228	1	1
Unmarried	132	264	1.04 (0.51–1.92)	1.01 (0.63–2.04)
Divorced	27	24	2.33 (1.29–4.33)	1.24 (0.97–3.91)
Widowed	9	12	1.55 (0.21–2.35)	1.14 (0.48–2.12)
Smoking
Never smoker	243	511	1	1
Former/current	35	17	4.33 (1.80–6.01)	3.06 (1.71–5.59)
Chat chewing
Never	225	462	1	1
Ever/current	53	66	1.65 (0.51–2.58)	1.58 (0.39–2.13)
Physical activity
Adequate	77	226	0.51 (0.19–0.91)	0.4 (0.09–0.89)
Inadequate	201	302	1	1
Epilepsy
Yes	161	242	1.63 (1.07–2.45)	1.58 (1.01–2.48)
No	117	286	1	1
BMI
Underweight	9	11	1.07 (0.52–2,99)	1.01 (0.95–2.60)
Normal	224	494	1	1
Overweight/ obese	45	23	4.31 (2.09–7.02)	3.16 (1.99–5.72)
Hypertension
Yes	44	20	4.78 (2.56–7.06)	3.48 (2.02–6.37)
No	234	508	1	1

Abbreviations: IQR, interquartile range; N, total number of participants (epileptic and non-epileptic).

Table 6 Factors Associated with ECG Abnormality Among Epileptic Patients at ARS Referral Hospitals, Ethiopia, 2022

Variables	ECG Abnormality (N = 403)		COR (95% CI)	AOR (95% CI)
	Yes	No
Residence
Urban	38	43	1	1
Rural	123	199	0.70 (0.32–1.26)	0.51 (0.22–1.08)
Marital status
Married	58	96	1	1
Unmarried	76	131	0.96 (0.51–1.72)	1.36 (0.49–1.34)
Divorced	21	9	3.86 (1.33–6.63)	2.39 (1.04–6.96)
Widowed	6	6	1.66 (0.31–4.75)	1.46 (0.40–3.14)
Educational status
Unable to read/ write	39	58	1	1
≤Grade 8	41	57	1.07 (0.54–2.38)	1.01 (0.42–1.63)
Grade 8–12	49	76	0.96 (0.52–1.73)	0.72 (0.25–1.52)
Diploma and above	32	51	0.63 (0.34–1.67)	0.60 (0.34–1.36)
Chat chewing
Never	128	208	1	1
Ever/current	33	34	1.58 (0.42–2.59)	1.04 (0.35–1.93)
Smoking
Never smoker	137	234	1	1
Former/current	24	8	5.12 (3.11–7.72)	4.66 (2.89–6.68)
Physical activity
Adequate	46	96	0.61 (0.14–0.97)	0.60 (0.12–0.91)
Inadequate	115	146	1	1
BMI
Underweight	6	6	1.69 (0.44–2.75)	1.41 (0.35–2.63)
Normal	134	227	1	1
Overweight/ obese	21	9	3.95 (2.29–5.02)	3.11 (2.14–4.96)
Hypertension
Yes	26	8	5.63 (2.92–9.01)	5.41 (2.82–9.31)
No	135	234	1	1
Duration of epilepsy (median±IQR)	10±7	8±6	1.99 (1.22–2.27)	1.15 (1.05–1.27)
Epilepsy control
Controlled	90	196	1	1
Uncontrolled	71	46	3.36 (1.83–6.47)	3.64 (1.57–5.86)
PDD to DDD ratio
<One	103	177	1	1
=One	58	65	1.53 (0.77–2.19)	1.19 (0.64–1.90)
Number of seizures in the last 3 months
None	130	206	1	1
One	17	22	1.22 (0.38–2.96)	1.02 (0.31–2.35)
>One	14	14	1.58 (0.80–3.05)	1.22 (0.23–5.97)

Abbreviations: IQR, interquartile range; N, total number of epileptic participants.

Table 7 Factors Associated with ECG Abnormality Among Outpatient Attendants of ARS Referral Hospitals, Ethiopia, 2022

Variables	ECG Abnormality (N = 403)		COR (95% CI)	AOR (95% CI)
	Yes	No
Age (median± IQR)	23±8	28±9	2.01 (0.76–3.24)	1.95 (0.74–3.02)
Sex
Male	64	150	1	1
Female	53	139	0.89 (0.46–1.72)	0.87 (0.43–1.69)
Marital status
Married	52	132	1	1
Unmarried	56	133	1.07 (0.49–1.74)	1.03 (0.53–1.84)
Divorced	6	15	1.02 (0.77–1.73)	1.08 (0.66–1.91)
Widowed	3	6	1.27 (0.32–2.35)	1.25 (0.35–2.22)
Smoking
Never smoker	106	277	1	1
Former/current	11	9	3.19 (1.40–5.11)	1.09 (1.03–2.09)
Chat chewing
Never	97	254	1	1
Ever/current	20	32	1.64 (0.71–3.01)	1.11 (0.21–2.99)
Physical activity
Adequate	31	130	0.43 (0.02–0.71)	0.23 (0.01–0.68)
Inadequate	86	156	1	1
BMI
Underweight	3	5	1.78 (0.32–2,18)	1.15 (0.81–2.14)
Normal	90	267	1	1
Overweight/ obese	24	14	5.10 (2.02–6.91)	3.00 (1.04–5.04)
Hypertension
Yes	18	12	4.15 (1.96–6.01)	2.99 (1.94–5.03)
No	99	274	1	1

Abbreviations: IQR, interquartile range; N, total number of non-epileptic participants.