Wednesday, 21 May 2014

Death and MS UK

The grim reaper stalks MSers in the UK #MSBlog #MSResearch

"The paper below complements my recent post discussing increased mortality in MSers. What is clear is that MS itself, and its complications, are a common cause of death amongst MSers. This is not surprising considering how much trouble some of the complications cause. Therefore switching off ongoing damage from MS, or even better curing people of MS, to prevent these complications should normalise life expectancy in MSers. Another aspect that is being increasingly recognised amongst MSers is the development of secondary co-morbidities. Ongoing systemic inflammation damages the lining of blood vessels and increases your chance of developing cardiovascular disease. This phenomenon is well described in rheumatoid arthritis, HIV and other other chronic inflammatory diseases. It now turns out that this also occurs in MS. Therefore we need to control inflammation in MS to reduce the development of secondary comorbidities. This is why we need a holistic approach to the management of MS with a focus on all aspects of the disease not just one narrow world-view of the disease. For example, whose job is it to educate MSers about the impact of smoking on their disease course and life expectancy? The aim of treating MS should not only to keep the grim reaper at bay for as long as possible and but to help MSers maintain a good quality of life as possible. The latter takes a lot of thought and care."

Epub: Jick et al. Mortality of patients with multiple sclerosis: a cohort study in UK primary care. J Neurol. 2014 May.

Background: MS increases mortality and reduces life expectancy by approximately 8 to 10 years.

Aims: We aimed to estimate rates, causes and risk factors of all-cause mortality in a large population-based cohort of MSers compared with patients without MS. 

Methods: Using data from the UK General Practice Research Database, we identified MSers diagnosed during 2001-2006 and validated using their original records where possible. We also included MSers during 1993-2000 identified and validated in an earlier study. Cases were matched to up to ten referents without MS by age, sex, index date (date of first MS diagnosis for cases and equivalent reference date for controls), general practice and length of medical history before first MS diagnosis. Patients were followed up to identify deaths; hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using Cox-proportional regression. 

Results: MSers (N = 1,822) had a significantly increased risk of all-cause mortality compared with referents (N = 18,211); adjusted HR 1.7 (95 % CI 1.4-2.1). Compared with referents, female MS patients had a higher but not significantly different HR for death than males; adjusted HR 1.86 (95 % CI 1.46-2.38) vs. HR 1.31 (95 % CI 0.93-1.84), respectively. The most commonly recorded cause of death in MS patients was 'MS' (41 %), with a higher proportion recorded among younger patients. A significantly higher proportion of referents than MS patients had cancer recorded as cause of death (40 vs. 19 %). 

Conclusions: MSers have a significant 1.7-fold increased risk of all-cause mortality compared with the general population. MS is the most commonly recorded cause of death among MSers.

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