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Published on: December 9, 2015
Comparison of 2 Methods for Estimating Multiple Sclerosis-Related Mortality
Fabien Rollot1, Zoé Uhry1, Emmanuelle Dantony1
1From the Université de Lyon (F.R., S.V.), Université Claude Bernard Lyon 1; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation (F.R., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Observatoire Français de la Sclérose en Plaques (F.R., S.V.), Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292; EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis (F.R., S.V.), State-Approved Foundation, Bron; Direction des Maladies non Transmissible et des Traumatismes (Z.U.), Santé Publique France, Saint-Maurice; Service de Biostatistique-Bioinformatique (Z.U., E.D., M.F., L.R.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Evolutive UMR 5558 (E.D., M.F., L.R.), Université Lyon 1 and CNRS, Villeurbanne; Service de Neurologie (M.D.), Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Neurology Department (E.L.P.), CRCSEP Rennes, Clinical Investigation Centre CIC-P 1414, Rennes University Hospital; Service de Neurologie (J.C.), CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) (J.C.), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III; Service de Neurologie (A.R.), CRC SEP, CHU de Bordeaux; U1215 INSERM (A.R.), Neurocentre Magendie, Université de Bordeaux; Service de Neurologie et Centre d'Investigation Clinique (J.D.S.), CHU de Strasbourg, INSERM 1434; Pôle des Neurosciences et de l'Appareil Locomoteur (H.Z.), CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172; CRC SEP (P.L.), Service de Neurologie, CHU de Montpellier; Service de Neurologie (G.D.), CRC-SEP Normandie, CHU de Caen, Université Normandie; Service de Neurologie (C.L.-F.), Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS; Service de Neurologie (T.M.), CHU de Dijon; Service de Neurologie (D.A.L.), CHU Nantes; INSERM (D.A.L.), CIC 0004, CRTI-INSERM UMR U1064, Nantes; Service de Neurologie (E.B.), CHU de Besançon; Service de Neurologie (P.C.), CHU de Clermont-Ferrand, INSERM 1107 NeuroDol, Clermont-Ferrand; Aix Marseille University (J.P.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM; Service de Neurologie (E.T.), CHU de Nîmes; Institut de Génomique Fonctionnelle (E.T.), Université de Montpellier, CNRS, INSERM; Service de Neurologie (O.H.), CH de Poissy; Service de Neurologie (J.-P.C.), Hôpital Nord, CHU Saint-Étienne; and Univ Rennes (E.L.), EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, France.
The excess mortality framework (EMF) provides higher estimates for multiple sclerosis (MS) mortality probabilities compared to the cause-specific framework (CSF). EMF is advantageous as it does not require death certificates, simplifying MS mortality assessment.
Area of Science:
- Epidemiology
- Neurology
- Biostatistics
Background:
- Estimating multiple sclerosis (MS) mortality is complex.
- Two frameworks exist: cause-specific (CSF) and excess mortality (EMF).
- CSF requires death certificates, EMF does not.
Purpose of the Study:
- To compare CSF and EMF for estimating MS mortality probabilities (PMS).
- To evaluate PMS and other cause mortality (Pother) using both frameworks.
- To assess the impact of data requirements on mortality estimations.
Main Methods:
- Utilized French multiple sclerosis registry (OFSEP) data (n=37,524).
- Compared CSF and EMF in a subset with available death causes (n=4,004).
- Employed Aalen-Johansen method for CSF and excess mortality hazard for EMF.
Main Results:
- EMF yielded higher 30-year PMS estimates than CSF (e.g., 20.4% vs 16.2% in oldest group).
- CSF had significant probabilities of death from unknown causes.
- Estimated probabilities of being alive were similar across both frameworks.
Conclusions:
- EMF offers advantages by not relying on potentially suboptimal death certificates.
- EMF is conceptually more relevant, avoiding difficult attributions of MS causality in death.
- EMF simplifies the assessment of mortality in chronic diseases like MS.
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