Multiple cause of death analysis in multiple sclerosis

Abstract

ObjectiveTo gain a better understanding of the complex patterns of causes that contribute to death due to multiple sclerosis (MS) by assessing the relationship between MS and other causes of death listed on death certificates.MethodsMultiple cause of death data for all adult deaths (aged ≥18 years) in British Columbia, Canada, between 1986 and 2013 were accessed. All causes, as listed on the death certificate, whether underlying or contributing, were considered “any mention” causes. The associations between mention of MS on the death certificate and mention of other causes of death were examined by logistic regression, adjusted for age, sex, and calendar year (Bonferroni-corrected α level = 0.002). Findings were also sex-stratified.ResultsAmong 771,288 deaths, MS was mentioned on 2,153 certificates. If MS was mentioned (versus not mentioned), there was a greater chance that specific conditions contributed to the death: respiratory infection (adjusted odds ratio [aOR], 3.03 [95% confidence interval (CI), 2.73–3.36]), aspiration pneumonia (aOR, 7.15 [95% CI, 6.23–8.22]), urinary tract infection (UTI) (aOR, 10.2 [95% CI, 8.7–12.0]), other infection including sepsis (aOR, 1.34 [95% CI, 1.15–1.56]), and skin disease (aOR, 5.06 [95% CI, 3.96–6.46]). Sex differences existed for urinary tract infection (men: aOR, 14.9 [95% CI, 11.5–19.3]; women: aOR, 8.00 [95% CI, 6.53–9.81]) and chronic respiratory disease (men = aOR, 1.36 [95% CI, 1.14–1.63]; women = aOR, 0.97 [95% CI, 0.84–1.13]).ConclusionsDeaths attributed to MS were commonly caused by infection (especially respiratory and urinary tract–related); conditions associated with advanced disability and immobility, such as aspiration pneumonia; and chronic respiratory disease in men. All are potentially modifiable; interventions that reduce the frequency or severity of these complications could improve survival in MS.

End of life in multiple sclerosis: Disability, causes and place of death among cases diagnosed from 1981 to 2010 in Pirkanmaa hospital district in Western Finland

“…There is increasing understanding on circumstances and complex patterns that contribute to death due to MS (Harding et al, 2020). Also, the complex conditions related to advanced disability and immobility (Harding et al, 2020) point at need for individual advanced care planning in MS (Davies et al, 2016;Sleeman et al, 2013;Strupp et al, 2014).…”

Autoimmunity increases susceptibility to and mortality from sepsis

“…Similar to the LPS endotoxemia model, S. pneumoniae infection in this system does not lead to mortality in unmanipulated mice. It does, however, represent a relevant respiratory infection (Bogaert et al, 2004), which are both a common cause of sepsis (Jeganathan et al, 2017) and a frequent complication among MS patients (Harding et al, 2020). Further host ability to control the infection can be assessed by determining the number of colony forming units (CFUs) in the lungs and plasma cytokines to give an indication of the host ability to mount an inflammatory response and clear infection.…”

“…Patients with autoimmune diseases, such as MS, are often treated with immunomodulatory drugs that may increase their susceptibility to infection and sepsis. For example, urinary tract infection (UTI) and respiratory infection, are both a common causes of sepsis (Jeganathan et al, 2017) and complications for MS patients, relative to the general population (Harding et al, 2020;Medeiros Junior et al, 2020). In fact, compared to the general healthy population, individuals with MS are at greater risk of sepsis, sepsis-induced complications, and death due to infection (Capkun et al, 2015).…”

Urinary Tract Infection in Patients with Multiple Sclerosis: An Overview

“…The adjusted Odds Ratio (aOR) was 10.2 with a 95% confidence interval (CI), 8.7-12.0. Also, a gender difference for the death causes of UTI was found (men: aOR, 14.9 [95% CI, (Harding et al, 2020).…”