Excess mortality among patients with multiple sclerosis in Denmark has dropped significantly over the past six decades: a population based study

被引:63
|
作者
Koch-Henriksen, Nils [1 ,2 ]
Laursen, Bjarne [3 ]
Stenager, Egon [2 ,4 ]
Magyari, Melinda [2 ,5 ]
机构
[1] Univ Aarhus, Dept Clin Epidemiol, Inst Clin, Aarhus, Denmark
[2] Univ Copenhagen, Rigshosp, Danish Multiple Sclerosis Registry, Sect 7801 Blegdamsvej 9, DK-2100 Copenhagen, Denmark
[3] Univ Southern Denmark, Natl Inst Publ Hlth, Copenhagen, Denmark
[4] Univ Southern Denmark, Inst Reg Hlth Res, Odense, Denmark
[5] Univ Copenhagen, Dept Neurol, Danish Multiple Sclerosis Ctr, Rigshosp, Copenhagen, Denmark
关键词
DIAGNOSTIC-CRITERIA; BRITISH-COLUMBIA; SURVIVAL; DEATH; DISABILITY; PROGRESSION; GUIDELINES; PATTERN; COHORT; TRENDS;
D O I
10.1136/jnnp-2017-315907
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Lifetime expectancy in multiple sclerosis (MS) is reduced. Few studies have had sufficient follow-up or sufficient number of patients to assess if survival has improved with time. However, a recent meta-analysis found no time-dependent change in MS excess mortality across studies over recent decades. Objective To investigate whether short-term all-cause excess mortality in patients with MS in the total Danish population has changed over the last six decades. Patients and methods We included all patients with MS recorded in the nationwide Danish MS Registry with definite or probable MS and onset from 1950 through 1999. The Danish Civil Registration System provided date of death for all deceased patients with follow-up in 2015, and Statistics Denmark supplied specific population mortality. We calculated excess number of death per 1000 person-years (EDR) and standardised mortality ratio (SMR). Results We included 18 847 patients among whom 6102 had died as opposed to 2492 expected deaths. EDR was 10.63 (95% CI 10.19 to 11.09) and a SMR was 2.45 (95% CI 2.39 to 2.51). The 15-year EDR dropped gradually from 11.29 (95% CI 9.95 to 12.73) in the 1950-1959 onset cohort to 2.56 (95% CI 1.98 to 3.18) in the 1990-1999 onset cohort, and SMR dropped from 4.48 (95% CI 4.06 to 4.92) to 1.80 (95% CI 1.62 to 1.99). Conclusion The decline in short-term excess mortality in MS started decades before disease-modifying treatment of MS became available, before use of MRI became widespread, and before the McDonald diagnostic criteria were introduced. A change in the MS cohorts with fewer malignant cases may be a significant contributor.
引用
收藏
页码:626 / 631
页数:6
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