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Updated: Apr 25, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Causes of death among commercially insured multiple sclerosis patients in the United States
Douglas S Goodin1, Michael Corwin2, David Kaufman3
1Department of Neurology, University of California San Francisco, San Francisco, California, United States of America.
Background:
Information on causes of death (CODs) for patients with multiple sclerosis (MS) in the United States is sparse and limited by standard categorizations of underlying and immediate CODs on death certificates. Prior research indicated that excess mortality among MS patients was largely due to greater mortality from infectious, cardiovascular, or pulmonary causes.
Objective:
To analyze disease categories in order to gain insight to pathways, which lead directly to death in MS patients.
Methods:
Commercially insured MS patients enrolled in the OptumInsight Research database between 1996 and 2009 were matched to non-MS comparators on age/residence at index year and sex. The cause most-directly leading to death from the death certificate, referred to as the "principal" COD, was determined using an algorithm to minimize the selection of either MS or cardiac/pulmonary arrest as the COD. Principal CODs were categorized into MS, cancer, cardiovascular, infectious, suicide, accidental, pulmonary, other, or unknown. Infectious, cardiovascular, and pulmonary CODs were further subcategorized.
Results:
30,402 MS patients were matched to 89,818 controls, with mortality rates of 899 and 446 deaths/100,000 person-years, respectively. Excluding MS, differences in mortality rate between MS patients and non-MS comparators were largely attributable to infections, cardiovascular causes, and pulmonary problems. Of the 95 excessive deaths (per 100,000 person-years) related to infectious causes, 41 (43.2%) were due to pulmonary infections and 45 (47.4%) were attributed to sepsis. Of the 46 excessive deaths (per 100,000 person-years) related to pulmonary causes, 27 (58.7%) were due to aspiration. No single diagnostic entity predominated for the 60 excessive deaths (per 100,000 person-years) attributable to cardiac CODs.
Conclusions:
The principal COD algorithm improved on other methods of determining COD in MS patients from death certificates. A greater awareness of the common CODs in MS patients will allow physicians to anticipate potential problems and, thereby, improve the care that they provide.
Insights
Multiple sclerosis (MS) patients experience higher mortality rates, primarily due to infections, cardiovascular, and pulmonary issues. Understanding these causes of death (CODs) can improve patient care and outcomes.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Information on causes of death (CODs) in multiple sclerosis (MS) patients is limited.
- Prior research suggests MS patients have higher mortality from infectious, cardiovascular, or pulmonary causes.
Purpose of the Study:
- To analyze disease categories leading to death in MS patients.
- To gain insight into the pathways directly causing mortality in MS.
Main Methods:
- Matched 30,402 MS patients to 89,818 non-MS comparators (1996-2009).
- Utilized an algorithm to determine the principal cause of death (COD) from death certificates, minimizing bias towards MS or cardiac/pulmonary arrest.
- Categorized principal CODs into MS, cancer, cardiovascular, infectious, suicide, accidental, pulmonary, other, or unknown.
Main Results:
- MS patients had higher mortality rates (899 vs. 446 deaths/100,000 person-years).
- Excess mortality in MS was mainly due to infections (43.2% pulmonary infections, 47.4% sepsis) and pulmonary causes (58.7% aspiration).
- Cardiovascular causes contributed significantly to excess deaths, but no single entity predominated.
Conclusions:
- The principal COD algorithm offers improved accuracy for determining mortality in MS patients.
- Increased awareness of common CODs in MS can help physicians anticipate complications and enhance patient care.
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