Patterns Of Comorbidity In Elderly Patients With Multiple Sclerosis
Fleming ST; Blake RL Jr
J Clin Epidemiol 1994 Oct;47(10):1127-32
Univ of Missouri, Columbia 65211, USA
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.
HLA and Prognosis in Multiple Sclerosis
Runmarker B; Martinsson T; Wahlstrom J; Andersen O
J Neurol 1994 May;241(6):385-90
Sahlgren's Hospital, Dept of Neurology, Goteborg, Sweden
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.
Epidemiology Of Multiple Sclerosis In US Veterans. VIII. Long-Term Survival After Onset Of Multiple Sclerosis
Wallin MT, Page WF, Kurtzke JF
Brain 2000 Aug;123 ( Pt 8):1677-87
Veterans Affairs Medical Center and Georgetown University Medical School, Neurology Service, Washington, DC 20422, USA
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.
Trends In Survival And Cause Of Death In Danish Patients With Multiple Sclerosis
Bronnum-Hansen H, Koch-Henriksen N, Stenager E
Brain 2004 Apr;127(Pt 4):844-50
National Institute of Public Health, Copenhagen O, Denmark
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.
Causes Of Unexpected Death In Patients With Multiple Sclerosis: A Forensic Study Of 50 Cases
Riudavets MA, Colegial C, Rubio A, Fowler D, Pardo C, Troncoso JC
Am J Forensic Med Pathol 2005 Sep;26(3):244-9
Johns Hopkins University School of Medicine, Division of NeuroPathology, Department of Pathology, Baltimore, Maryland 21287, USA
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.
- In Group A, 21 (42%) cases, deaths were directly related to a Neurologic complication
- 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%)
- 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.
But, a large proportion appears to be due to other causes such as accidents and trauma. Thus, it seems likely that taking specific precautions could prevent some deaths in MS.