Mortality of patients with multiple sclerosis: a cohort study in UK primary care

Abstract

We aimed to estimate rates, causes and risk factors of all-cause mortality in a large population-based cohort of multiple sclerosis (MS) patients compared with patients without MS. Using data from the UK General Practice Research Database, we identified MS cases diagnosed during 2001–2006 and validated using patients’ original records where possible. We also included MS cases during 1993–2000 identified and validated in an earlier study. Cases were matched to up to ten referents without MS by age, sex, index date (date of first MS diagnosis for cases and equivalent reference date for controls), general practice and length of medical history before first MS diagnosis. Patients were followed up to identify deaths; hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using Cox-proportional regression. MS patients (N = 1,822) had a significantly increased risk of all-cause mortality compared with referents (N = 18,211); adjusted HR 1.7 (95 % CI 1.4–2.1). Compared with referents, female MS patients had a higher but not significantly different HR for death than males; adjusted HR 1.86 (95 % CI 1.46–2.38) vs. HR 1.31 (95 % CI 0.93–1.84), respectively. The most commonly recorded cause of death in MS patients was ‘MS’ (41 %), with a higher proportion recorded among younger patients. A significantly higher proportion of referents than MS patients had cancer recorded as cause of death (40 vs. 19 %). Patients with MS have a significant 1.7-fold increased risk of all-cause mortality compared with the general population. MS is the most commonly recorded cause of death among MS patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s00415-014-7370-3) contains supplementary material, which is available to authorized users.

Prevalence of Multiple Sclerosis in Saudi Arabia

“…The crude death rate for MS patients was 9.1 (95 % CI 7.6-10.8) per 1,000 person-years compared with 4.0 (95 % CI 3.6-4.3) per 1,000 person-years for 1583 the non-MS counterparts. Mortality rates were higher in MS patients compared with their matched controls in each age group and for both males and females 6 .…”

What Role Does Tobacco Smoking Play in Multiple Sclerosis Disability and Mortality? A Review of the Evidence

“…Additionally they showed that patients who were older at onset or diagnosed with PPMS have shorter survival and that there was conflicting research on sex and mortality. The cause of death in the majority of cases was MS-related varying between 41% [19] and 75% [23]. Deaths unrelated to MS were similar to the general population: cardiovascular disease, cancer and infections.…”

“…Suicide was much more prevalent in patients with MS but the data on the other causes is less consistent. Cancer has been reported as both decreased in MS patients [20] and significantly increased in other cohorts [19].…”

“…Though there are some inconsistencies the accumulated epidemiological evidence points to tobacco smoke being correlated with increased susceptibility [2,[6][7][8][9][10], faster clinical progression [11][12][13][14][15][16][17] and increased mortality in patients with MS [18][19][20][21][22][23]. The pathological basis for this is currently unknown but there are some putative mechanisms.…”

“…The cause of death in patients with MS has been studied extensively in multiple cohorts and registries [18][19][20][21]23] the standardized mortality ratios (SMR) for all-cause mortality in patients with MS varied between 1.3 and 2.88 when compared with the matched general population [23]. They concluded that the available evidence showed highly variable times to death from birth and from disease onset/diagnosis.…”