Multiple Sclerosis Mortality Statistics

An Epidemiologic study has been performed on the relation between the mortality rates from Multiple Sclerosis for the period 1983-1989 obtained for 36 countries, Dietary Fat, and Latitude.

By stepwise multiple regression analysis, Saturated Fatty Acids, Animal Fat, Animal Minus Fish Fat, and Latitude correlated independently and positively with Multiple Sclerosis mortality (p 0.01-0.001 for Fat Consumption, and p 0.05-0.01 for Latitude).

The ratio of Polyunsaturated Fatty Acids to Saturated Fatty Acids (P/S ratio) and the ratio of Unsaturated Fatty Acids (MonoUnsaturated and PolyUnsaturated Fatty Acids) to Saturated Fatty Acids (U/S ratio) correlated independently and negatively with Multiple Sclerosis mortality (p 0.05-0.001).

These findings support the hypothesis linking dietary fat intake and latitude to Multiple Sclerosis mortality.

We estimated survival probability and excess death rates for patients with MS on the basis of data from the Danish Multiple Sclerosis Registry, which includes virtually all patients diagnosed with MS in Denmark (population, five million) since 1948.

We reviewed and reclassified all case records according to standardized diagnostic criteria. By linkage to the Danish Central Population Registry, we lost to follow-up only 25 patients who had emigrated.

The median survival time from onset of the disease was 28 years in men (compared with 40 years in the matched general male population) and 33 years in women (versus 46 years).

The median survival time from diagnosis was 22 years in men (versus 37 years) and 28 years in women (versus 42 years).

The excess death rate between onset and follow-up (observed deaths per 1,000 person-years minus the expected number of deaths in a matched general population) was 14.3 in men, which was significantly higher than in women (12.0).

Excess mortality increased with age at onset of MS in people of each sex. The 10-year excess death rate has decreased significantly in recent decades. Excess mortality was highest in cases with Cerebellar Symptoms at onset.

Gompertzian analyzes of mortality data have recently been undertaken for a number of individual conditions [Comments In].

Such analyzes are in principle of particular epidemiological value in circumstances where demographic change is occurring and where the balance between mortality from different conditions is subject to change.

However, the extent to which a Gompertzian relationship between age and mortality holds for particular conditions has been subject to debate.

In this analysis it is demonstrated that even some conditions which do not superficially hold to a Gompertz relationship do in fact do so, if such conditions are considered to be restricted to small, inherently susceptible subpopulations.

By analyzing mortality from a range of neurological conditions within the context of general mortality in England and Wales, conditions with different aetiologies such as Huntington's Chorea, Amyotrophic Lateral Sclerosis and Multiple Sclerosis can be shown to have a Gompertzian mortality rate distribution.

Such analyzes are of substantial value in indicating how demographic change affects the balance of mortality between conditions, as well as directing interest to revised aetiological possibilities.

Comments In
[1] Riggs JE. Mech Ageing Dev 1990; 55: 207-220
[2] Neilson S et al. Mech Ageing Dev 1992; 64: 201-216
[3] Neilson S et al. Acta Neurol Scand 1993; 87: 184-191

The mortality from Motor Neuron Disease (MND) and Multiple Sclerosis (MS) was studied among immigrants to England and Wales from the Indian subcontinent, the Caribbean, and East and West Africa during the 10 years 1979-88.

The MND mortality among ethnic Asian males was only half and for females one fifth of that expected at English rates. MND mortality in Caribbean immigrants was somewhat lower than expected.

White immigrants from the Indian subcontinent had the expected MND mortality. MS mortality was low among Asian, West Indian, and African immigrants. This study is evidence that MND mortality is not the same in all ethnic groups.

The natural history of MS is highly variable. There is substantial Heterogeneity in the clinical manifestations but, at this point, it is reasonable to consider all idiopathic inflammatory DeMyelinating Diseases of the Central Nervous System as representing a spectrum of the same disease.

In large populations, 20% to 40% have "Benign Disease," defined as having less than moderate disability after 10 years. Benign is a potentially misleading term because many of these patients subsequently will become disabled.

Half will develop Progressive MS within 10 years and will require some form of walking aid within 15 years following the onset of MS. Survival is not greatly shortened in mildly disabled patients, but the observed mortality is increased four-fold over the general population in patients with advanced disability.

Patients with the greatest risk of disability are those with PP MS and RR patients who are older at onset, have Pyramidal or Cerebellar involvement at onset, and who have frequent or prolonged attacks with incomplete recovery.

The biological basis for the variation in the course of MS is understood only in a very limited way. The short- and long-term course of MS may be determined by different biological variables.

Short-term benefit in clinical trials should not be assumed to indicate long-term reduction in the risk of permanent Disability.

A regional survey of Multiple Sclerosis (MS) patients in Wellington, New Zealand in 1983 identified 245 patients, giving a prevalence (all categories included) of 72 per 100,000.

Retrospective review of the history and medical records identified a poorer prognosis for disability where there was progressive onset of symptoms, Secondary/Progressive after a Remitting phase, Older age of onset (40 years or more), or a Motor Syndrome involving the limbs at presentation.

In 1983 follow up data were obtained on 96 patients who were seen during a previous survey in 1968.

For those with definite or probable MS, progression to severe disability (Kurtzke Disability Status Scale (DSS) 6-9) or death (DSS 10) was seen in 26/34 with moderate disability (DSS 3-5) in 1968 and in only 5/29 with mild disability (DSS 0-2).

When the analysis is confined to those with symptoms for at least five years in 1968, severe disability or death from MS occurred in 22/30 with moderate nd 4/19 with mild disability (chi 2 = 10.8, p = 0.001).

It is concluded that the patient's established disability level after five years of illness is a useful, but not infallible, prognostic indicator.

From the follow up of the 1968 patients, the probability of MS-related mortality for a given disease duration was calculated.

Using this survival distribution to adjust the disability ratings in the 1983 population, it was found that the proportion with mild disability decreased steadily with increasing disease duration, reaching 14% when the disease duration was more than 25 years.

This study explored the prevalence of comorbid conditions in hospitalized patients with Multiple Sclerosis (MS) who were 65 years of age or older.

Using 1989 data from the Quality of Care Medicare Provider Analysis and Review (MEDPAR) file, hospitalized MS patients were compared with respect to discharge diagnoses to an age- and sex-matched group of hospitalized patients without MS.

As expected, the following discharge diagnoses were more common (P 0.05) for MS patients: Urinary Tract Infection, Pneumonia, Septicemia and Cellulitus.

In contrast, MS patients were less likely (P 0.05) to have discharge diagnoses of Acute Myocardial Infarction, Heart Failure, Hypertension, Angina Pectoris, Cerebrovascular Disease, Diabetes Mellitus and Chronic Obstructive Pulmonary Disease.

Possible explanations include under-reporting of certain comorbid conditions on discharge records of MS patients, a protective effect of MS or its treatment, reduced prevalence of risk factors, disproportionate mortality in younger MS patients with comorbidity and the benefits of medical surveillance.

The patients of a Multiple Sclerosis (MS) incidence cohort with 25 years of longitudinal follow-up were typed for HLA-DR and DQ.

This type of cohort provides reliable data for Gene frequencies and prognostic studies. The influence of sampling bias, mainly due to mortality during the long follow-up, was accounted for.

A positive association between MS and DR15,DQ6 was confirmed, but this haplotype did not influence prognosis. There was no difference in haplotype frequency between Relapsing/Remitting and Primary Chronic Progressive MS.

DR17, DQ2 was significantly over-represented in the quartile with the most malignant course. The haplotype DR1, DQ5, which was found rather less frequently in MS patients, also tended to be associated with a poorer prognosis.

Survival to 1996 was analysed for nearly 2500 veterans of World War II who were rated as 'service-connected' for Multiple Sclerosis as of 1956 by the then Veterans Administration.

Survival from onset was defined for all white women and black men, and a random sample of white men. Median survival times from onset were 43 years (white females), 30 years (black males) and 34 years (white males).

Crude 50-year survival rates were 31.5% (white females), 21.5% (black males) and 16.6% (white males), but only the white females and white males were significantly different.

A proportional hazard analysis was used to identify risk factors for mortality from Multiple Sclerosis onset year.

Significant risk factors included male sex (risk ratio: 1.57), older age at onset (risk ratio: 1.05 per year) and high socioeconomic status (risk ratio: 1.05 per socioeconomic status category).

There were no statistically significant differences in survival following Multiple Sclerosis onset by race or latitude of place of entry into military service, both significant risk factors associated with the development of Multiple Sclerosis.

Standardized mortality ratios utilizing national US data (for 1956-96) showed a marked excess for all three race-sex groups of Multiple Sclerosis cases, with little difference among them, but with a decreasing excess over time.

Relative survival rates, used to compare the survival of Multiple Sclerosis cases with that of other military veterans, did not differ significantly by sex-race group, nor by latitude of place of entry into military service, but did differ significantly by socioeconomic class.

The lack of difference in male and female relative survival rates suggests that the significant difference in survival between male and female Multiple Sclerosis cases is, at least in part, a result of sex per se and not the disease.

The Danish Multiple Sclerosis Registry contains information about all Danish patients in whom Multiple Sclerosis has been diagnosed since 1948.

The purpose of this study was to analyze trends in survival and causes of death of these patients and to compare them with those of the general population.

The study comprised all patients with onset in the period 1949-1996. All case records were validated and classified according to standardized diagnostic criteria.

Data on emigration and death were obtained by record linkage to official registers. The end of follow-up was 1 January 2000 for emigration and death, and 1 January 1999 for cause-specific deaths.

Standardized mortality ratios and excess death rates were calculated for various causes of death and periods after Multiple Sclerosis onset, and time trends in survival probability were analyzed by Cox regression.

The study comprised 9,881 patients, of whom 4,254 had died before end of follow-up.

The median survival time from onset was approximately 10 years shorter for Multiple Sclerosis patients than for the age-matched general population, and Multiple Sclerosis was associated with an almost threefold increase in the risk for death.

According to death certificates, more than half (56.4%) of the patients had died from Multiple Sclerosis. They also had excess mortality rates from other diseases, except Cancer, and from accidents and suicide.

The probability for survival improved significantly during the observation period. Thus, the 10-year excess mortality was almost halved in comparison with that in the middle of the 1900s.

To determine the cause of death (as a result of Neurologic or NonNeurologic complications or accidents) in patients with Multiple Sclerosis (MS).

We reviewed the autopsies of 50 subjects with MS from the Office of the Chief Medical Examiner of Maryland (OCME) between 1982 and 2004.

The series included 32 females and 18 males (mean age, 45.8 years; range, 25-69 years) and the causes of death were classified into 3 categories: (A) Neurologic complication directly related to MS; (B) NonNeurologic complications or other medical causes; and (C) accidents, etc.

Of the 50 cases, in 43 there was a history of MS, but in 7 subjects there was not, and the diagnosis was established by NeuroPathologic Examination.
1. In Group A, 21 (42%) cases, deaths were directly related to a Neurologic complication
2. In Group B, 14 (28%) cases were related to the following NonNeurologic and medical causes: ASCVD 9 (18%), Metabolic Disorder 1 (2%), Pulmonary Embolism 3 (6%), and BronchoPneumonia 1 (2%)
3. In Group C, 15 (30%) cases, deaths were due to Trauma, 9 (18%); Intoxication, 5 (10%); and Thermal Injury, 1 (2%)

Thus, among the 50 subjects, in 26, deaths occurred naturally; and in 24, from accidents, homicides, suicides, or undetermined causes.

Pathologically, the majority of cases showed either chronic inactive (66.7%) or chronic active (15.6%) DeMyelinating lesions, mainly in the Cerebral Hemispheres.

In some cases, it appears that DeMyelinating lesions, involving Brain regions that regulate CardioRespiratory activity, could be considered as the immediate cause of death.