Citation

Lalmohamed A, Bazelier MT, Van Staa TP, Uitdehaag BM, Leufkens HG, de Boer A, De Vries F. Eur. J. Neurol. 2012; 19(7): 1007-1014.

Affiliation

Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands MRC Epidemiology Resource Centre, University of Southampton, Southampton General Practice Research Database, Medicines and Healthcare products Regulatory Agency, London, UK Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands.

Copyright

(Copyright © 2012, European Federation of Neurological Societies, Publisher John Wiley and Sons)

DOI

10.1111/j.1468-1331.2012.03668.x

PMID

22353360

Abstract

Background and purpose:  Multiple sclerosis (MS) has been associated with increased mortality rates. However, influence of lifestyle parameters remains unknown, and inconsistencies exist regarding findings for causes of death. Methods:  We conducted a population-based cohort study using the General Practice Research Database, Hospital Episode Statistics, and national death certificates (January 2001 through March 2008). To each patient with MS (n = 1270), up to six referent subjects without MS were matched by age, gender, and practice. Cox proportional hazards models were used to estimate mortality rate ratios (HRs). Results:  Patients with MS had a 3.5-fold increased mortality rate for all-cause mortality, compared with referent subjects (HR 3.51, 95% CI 2.63-4.69). The rate further increased amongst current smokers (HR 6.72, 95% CI 4.16-10.87) (but not in ex-smokers) and subjects with a body mass index of <20 kg/m(2) (HR 6.67, 95% CI 3.50-12.73). The HR was highest for infectious/respiratory-related deaths (HR 7.69, 95% CI 4.92-12.02) and was significantly increased for deaths related to cardiovascular diseases (2.4-fold) and cancer (1.9-fold), but not for accidents and suicide related deaths. Conclusion:  British patients with MS have a 3.5-fold increased mortality rate compared with the general population. Smoking and respiratory diseases are major (potentially preventable) factors related to increased mortality rate amongst patients with MS.

Language: en