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Survival Outcomes of Medicare-Covered Elderly US Population With Myasthenia Gravis
Yuebing Li1, David Bruckman2, Jesse D Schold3
1Department of Neurology, Cleveland Clinic, Cleveland, Ohio, USA.
Introduction/Aim:
Survival outcomes have been inadequately studied among people with myasthenia gravis (MG) in the United States (US). We examined the impact of MG and comorbid conditions on longevity.
Methods:
We performed a longitudinal study using Medicare claims data (2006-2019). Incident MG cohort was identified based on the following criteria: age ≥ 65 years; ≥ 1 month of fee-for-service Parts A and B coverage; no health maintenance organization coverage; initial and subsequent MG claims within 2010-2011 separated by ≥ 28 days. A non-MG cohort of five times the number of the MG group was selected, matching for age, sex, region, and Medicare coverage duration. Overall and cause-specific mortality were compared between cohorts in the subsequent 8-10 Years using Kaplan-Meier plots and Cox proportional hazard models, adjusted for the Charlson Comorbidity Index (CCI).
Results:
Cohorts of 6024 incident MG and 30,083 control beneficiaries were Included. The mortality rate was higher in the MG cohort compared to controls (66.8 vs. 57.1 per 1000-person-year, p < 0.0001). After adjusting for time-varying CCI, no significant difference in survival was observed between two cohorts (adjusted hazard ratio 1.09 [0.87-1.36], p = 0.47). Sixteen percent of deaths in the MG cohort were attributed to MG. Compared to the non-MG cohort, mortality rates (per 1000-person-year) specific to infections were higher among the MG cohort (2.0 vs. 1.2) while malignancies and dementia-specific mortality rates were lower (10.3 vs. 12.5 and 4.7 vs. 7.2), all p < 0.01.
Discussion:
Long-term mortality is increased in elderly MG patients compared to non-MG counterparts, driven by their higher comorbidity burden.
Insights
Elderly individuals with myasthenia gravis (MG) face increased long-term mortality, primarily due to a higher burden of comorbid conditions. This study highlights the impact of these comorbidities on survival outcomes in the US.
Area of Science:
- Neurology
- Epidemiology
- Geriatrics
Background:
- Survival outcomes in myasthenia gravis (MG) patients in the US remain understudied.
- Comorbid conditions significantly influence the health and longevity of individuals with MG.
Purpose of the Study:
- To investigate the impact of MG and coexisting health issues on long-term survival.
- To compare mortality rates between elderly MG patients and a matched non-MG cohort.
Main Methods:
- A longitudinal study utilized Medicare claims data from 2006-2019.
- Identified an incident MG cohort (age ≥ 65) and a matched non-MG control cohort.
- Compared overall and cause-specific mortality using Kaplan-Meier plots and Cox models, adjusting for the Charlson Comorbidity Index (CCI).
Main Results:
- The MG cohort (6024 individuals) exhibited a higher crude mortality rate than the control cohort (30,083 individuals).
- After adjusting for CCI, no significant survival difference was observed between the MG and control groups.
- MG accounted for 16% of deaths in the MG cohort; infection-specific mortality was higher, while malignancy and dementia-specific mortality were lower in the MG group.
Conclusions:
- Long-term mortality is elevated in elderly MG patients compared to their non-MG counterparts.
- The increased mortality risk in MG patients is largely attributable to their significant comorbidity burden.
- Understanding these factors is crucial for improving MG patient care and longevity.
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