Relative mortality and survival in multiple sclerosis: Findings from British Columbia, Canada

E. Kingwell, M. Van Der Kop, Y. Zhao, A. Shirani, F. Zhu, J. Oger, H. Tremlett

Research output: Contribution to journalArticle

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Abstract

Objective: To examine mortality and factors associated with survival in a population based multiple sclerosis (MS) cohort. Methods: Clinical and demographic data of MS patients registered with the British Columbia MS clinics (1980-2004) were linked to provincial death data, and patients were followed until death, emigration or study end (31 December 2007). Absolute survival and the influence of patient characteristics (sex, disease course (primary progressive (PPMS) vs relapsing onset (R-MS)) and onset age) were estimated by Kaplan-Meier analyses (from birth and disease onset). Mortality relative to the general population was examined using standardised mortality ratios. Excess mortality associated with patient characteristics and time period of cohort entry was assessed by relative survival modelling. Results: Of 6917 patients, 1025 died. Median survival age was 78.6 years (95% CI 77.5 to 79.7) for women and 74.3 years (95% CI 73.1 to 75.4) for men. Survival from onset was longer for R-MS (49.7 years; 95% CI 47.9 to 51.5) than for PPMS (32.5 years; 95% CI 29.5 to 35.7); however, survival age was similar. The overall standardised mortality ratios was 2.89 (95% CI 2.71 to 3.07), and patients survived approximately 6 years less than expected, relative to the general population. PPMS had a higher relative mortality risk compared with R-MS (relative mortality ratio (RMR) 1.52; 95% CI 1.30 to 1.80). Women with PPMS had a relative survival disadvantage compared with men with PPMS (RMR 1.55; 95% CI 1.19 to 2.01). Relative survival within 10 years of cohort entry was similar between time periods. Conclusions: Some of the longest MS survival times are reported here but the risk of death was still greater than in the age, sex and calendar year matched general population. No evidence of increased survival over time was found when improved survival in the general population was taken into consideration.

Original languageEnglish (US)
Pages (from-to)61-66
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume83
Issue number1
DOIs
StatePublished - Jan 2012

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British Columbia
Multiple Sclerosis
Canada
Survival
Mortality
Population
Emigration and Immigration
Kaplan-Meier Estimate
Age of Onset
Sex Characteristics
Demography
Parturition

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Relative mortality and survival in multiple sclerosis : Findings from British Columbia, Canada. / Kingwell, E.; Van Der Kop, M.; Zhao, Y.; Shirani, A.; Zhu, F.; Oger, J.; Tremlett, H.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 83, No. 1, 01.2012, p. 61-66.

Research output: Contribution to journalArticle

Kingwell, E. ; Van Der Kop, M. ; Zhao, Y. ; Shirani, A. ; Zhu, F. ; Oger, J. ; Tremlett, H. / Relative mortality and survival in multiple sclerosis : Findings from British Columbia, Canada. In: Journal of Neurology, Neurosurgery and Psychiatry. 2012 ; Vol. 83, No. 1. pp. 61-66.
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abstract = "Objective: To examine mortality and factors associated with survival in a population based multiple sclerosis (MS) cohort. Methods: Clinical and demographic data of MS patients registered with the British Columbia MS clinics (1980-2004) were linked to provincial death data, and patients were followed until death, emigration or study end (31 December 2007). Absolute survival and the influence of patient characteristics (sex, disease course (primary progressive (PPMS) vs relapsing onset (R-MS)) and onset age) were estimated by Kaplan-Meier analyses (from birth and disease onset). Mortality relative to the general population was examined using standardised mortality ratios. Excess mortality associated with patient characteristics and time period of cohort entry was assessed by relative survival modelling. Results: Of 6917 patients, 1025 died. Median survival age was 78.6 years (95{\%} CI 77.5 to 79.7) for women and 74.3 years (95{\%} CI 73.1 to 75.4) for men. Survival from onset was longer for R-MS (49.7 years; 95{\%} CI 47.9 to 51.5) than for PPMS (32.5 years; 95{\%} CI 29.5 to 35.7); however, survival age was similar. The overall standardised mortality ratios was 2.89 (95{\%} CI 2.71 to 3.07), and patients survived approximately 6 years less than expected, relative to the general population. PPMS had a higher relative mortality risk compared with R-MS (relative mortality ratio (RMR) 1.52; 95{\%} CI 1.30 to 1.80). Women with PPMS had a relative survival disadvantage compared with men with PPMS (RMR 1.55; 95{\%} CI 1.19 to 2.01). Relative survival within 10 years of cohort entry was similar between time periods. Conclusions: Some of the longest MS survival times are reported here but the risk of death was still greater than in the age, sex and calendar year matched general population. No evidence of increased survival over time was found when improved survival in the general population was taken into consideration.",
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AU - Kingwell, E.

AU - Van Der Kop, M.

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AU - Zhu, F.

AU - Oger, J.

AU - Tremlett, H.

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N2 - Objective: To examine mortality and factors associated with survival in a population based multiple sclerosis (MS) cohort. Methods: Clinical and demographic data of MS patients registered with the British Columbia MS clinics (1980-2004) were linked to provincial death data, and patients were followed until death, emigration or study end (31 December 2007). Absolute survival and the influence of patient characteristics (sex, disease course (primary progressive (PPMS) vs relapsing onset (R-MS)) and onset age) were estimated by Kaplan-Meier analyses (from birth and disease onset). Mortality relative to the general population was examined using standardised mortality ratios. Excess mortality associated with patient characteristics and time period of cohort entry was assessed by relative survival modelling. Results: Of 6917 patients, 1025 died. Median survival age was 78.6 years (95% CI 77.5 to 79.7) for women and 74.3 years (95% CI 73.1 to 75.4) for men. Survival from onset was longer for R-MS (49.7 years; 95% CI 47.9 to 51.5) than for PPMS (32.5 years; 95% CI 29.5 to 35.7); however, survival age was similar. The overall standardised mortality ratios was 2.89 (95% CI 2.71 to 3.07), and patients survived approximately 6 years less than expected, relative to the general population. PPMS had a higher relative mortality risk compared with R-MS (relative mortality ratio (RMR) 1.52; 95% CI 1.30 to 1.80). Women with PPMS had a relative survival disadvantage compared with men with PPMS (RMR 1.55; 95% CI 1.19 to 2.01). Relative survival within 10 years of cohort entry was similar between time periods. Conclusions: Some of the longest MS survival times are reported here but the risk of death was still greater than in the age, sex and calendar year matched general population. No evidence of increased survival over time was found when improved survival in the general population was taken into consideration.

AB - Objective: To examine mortality and factors associated with survival in a population based multiple sclerosis (MS) cohort. Methods: Clinical and demographic data of MS patients registered with the British Columbia MS clinics (1980-2004) were linked to provincial death data, and patients were followed until death, emigration or study end (31 December 2007). Absolute survival and the influence of patient characteristics (sex, disease course (primary progressive (PPMS) vs relapsing onset (R-MS)) and onset age) were estimated by Kaplan-Meier analyses (from birth and disease onset). Mortality relative to the general population was examined using standardised mortality ratios. Excess mortality associated with patient characteristics and time period of cohort entry was assessed by relative survival modelling. Results: Of 6917 patients, 1025 died. Median survival age was 78.6 years (95% CI 77.5 to 79.7) for women and 74.3 years (95% CI 73.1 to 75.4) for men. Survival from onset was longer for R-MS (49.7 years; 95% CI 47.9 to 51.5) than for PPMS (32.5 years; 95% CI 29.5 to 35.7); however, survival age was similar. The overall standardised mortality ratios was 2.89 (95% CI 2.71 to 3.07), and patients survived approximately 6 years less than expected, relative to the general population. PPMS had a higher relative mortality risk compared with R-MS (relative mortality ratio (RMR) 1.52; 95% CI 1.30 to 1.80). Women with PPMS had a relative survival disadvantage compared with men with PPMS (RMR 1.55; 95% CI 1.19 to 2.01). Relative survival within 10 years of cohort entry was similar between time periods. Conclusions: Some of the longest MS survival times are reported here but the risk of death was still greater than in the age, sex and calendar year matched general population. No evidence of increased survival over time was found when improved survival in the general population was taken into consideration.

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