Katharine Harding1, Valerie Anderson2, Owain Williams2, Mark Willis3, Sara Butterworth2, Emma Tallantyre4, Fady Joseph5, Mark Wardle4, Trevor Pickersgill4, Neil Robertson6. 1. Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom; Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom. Electronic address: katharineharding@doctors.org.uk. 2. Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom. 3. Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom; Department of Neurology, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, United Kingdom. 4. Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom. 5. Department of Neurology, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, United Kingdom. 6. Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom; Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
Abstract
BACKGROUND: Mortality studies in multiple sclerosis (MS) are valuable to identify changing disease patterns and inform clinical management. This study examines mortality in a British MS cohort. METHODS: Patients were selected from the southeast Wales MS registry. Hazard of death was analysed using Cox proportional hazards regression, adjusted for onset age, annualised relapse rate, initial disease course, time to EDSS 4.0, sex, socioeconomic status, and onset year. Age- and sex-stratified standardised mortality ratios (SMRs) were calculated by EDSS scores. RESULTS: Median time from MS diagnosis to death was 35.5 years and median age 73.9. Older onset age (hazard ratio [HR] 1.05, 95% confidence interval 1.03-1.06) was associated with increased hazard of death. Primary progressive course was associated with increased hazard of death in women (HR 2.04, 1.15-3.63) but not men (HR 1.23, 0.61-2.47). Slow time to EDSS 4.0 (HR 0.41, 0.28-0.60) and high socioeconomic status (HR 0.54, 0.37-0.79) were associated with reduced hazard of death. SMR increased from EDSS 6.0 (3.86, 2.63-5.47) but more substantially at EDSS 8.0 (22.17, 18.20-26.75). CONCLUSIONS: Risk of death in MS varies substantially with degree of disability. This has important implications for clinical management and health economic modelling.
BACKGROUND: Mortality studies in multiple sclerosis (MS) are valuable to identify changing disease patterns and inform clinical management. This study examines mortality in a British MS cohort. METHODS: Patients were selected from the southeast Wales MS registry. Hazard of death was analysed using Cox proportional hazards regression, adjusted for onset age, annualised relapse rate, initial disease course, time to EDSS 4.0, sex, socioeconomic status, and onset year. Age- and sex-stratified standardised mortality ratios (SMRs) were calculated by EDSS scores. RESULTS: Median time from MS diagnosis to death was 35.5 years and median age 73.9. Older onset age (hazard ratio [HR] 1.05, 95% confidence interval 1.03-1.06) was associated with increased hazard of death. Primary progressive course was associated with increased hazard of death in women (HR 2.04, 1.15-3.63) but not men (HR 1.23, 0.61-2.47). Slow time to EDSS 4.0 (HR 0.41, 0.28-0.60) and high socioeconomic status (HR 0.54, 0.37-0.79) were associated with reduced hazard of death. SMR increased from EDSS 6.0 (3.86, 2.63-5.47) but more substantially at EDSS 8.0 (22.17, 18.20-26.75). CONCLUSIONS: Risk of death in MS varies substantially with degree of disability. This has important implications for clinical management and health economic modelling.