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Causes that Contribute to the Excess Mortality Risk in Multiple Sclerosis: A Population-Based Study
Elaine Kingwell1, Feng Zhu2, Charity Evans3
1Faculty of Medicine and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada, elainejk@mail.ubc.ca.
Neuroepidemiology
|December 19, 2019
Summary
Multiple sclerosis (MS) patients face significantly higher mortality risks from infections, cardiovascular disease, and suicide compared to the general population. MS itself is the most frequent underlying cause of death, highlighting the disease
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Multiple sclerosis (MS) is associated with a 6-10 year reduction in lifespan, but the underlying causes of this mortality gap remain incompletely understood.
- Existing research has not fully elucidated the specific causes of death contributing to reduced longevity in MS patients.
Purpose of the Study:
- To compare cause-specific mortality in a cohort of multiple sclerosis patients with the general population.
- To identify the primary drivers of increased mortality risk in individuals with MS.
Main Methods:
- Utilized linked clinical and population-based administrative health databases in British Columbia, Canada, for a cohort of MS patients.
- Followed patients from their first MS clinic visit or January 1, 1986, until death or December 31, 2013.
- Calculated standardized mortality ratios (SMRs) for underlying causes and relative mortality ratios (RMRs) for any mentioned cause, compared to age-, sex-, and calendar year-matched general population data.
Main Results:
- All-cause mortality risk was 2.71 times higher in MS patients compared to the general population.
- Genitourinary infections (SMR 3.55), respiratory diseases (SMR 2.69), suicide (SMR 2.40), cardiovascular disease (SMR 1.57), and septicemia (SMR 1.83) were significant causes of increased mortality.
- While underlying cause mortality for accidents and endocrine diseases was similar, any mention of these causes showed increased risk (RMR 2.71 for accidents, RMR 1.75 for endocrine diseases).
- Increased bladder cancer mortality was observed in women with MS (SMR 3.87).
Conclusions:
- Multiple sclerosis itself is the most frequent underlying cause of death in MS patients.
- Infections, suicide, cardiovascular disease, and accidents significantly contribute to the elevated mortality risk in the MS population.
- Utilizing multiple-cause of death data provides a more comprehensive understanding of mortality in MS compared to solely examining underlying causes.
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