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PLoS One. 2015 Jul 6;10(7):e0132033. doi: 10.1371/journal.pone.0132033. eCollection 2015.

Excess Mortality in Patients with Multiple Sclerosis Starts at 20 Years from Clinical Onset: Data from a Large-Scale French Observational Study.

Author information

1
Department of Epidemiology, EHESP Rennes, Sorbonne Paris Cité; CIC-P 1414, CHU Rennes, West Neuroscience Network of Excellence (WENNE), Rennes, France.
2
Department of Neurology, CHU Lyon, Observatoire Français de la Sclérose En Plaques (OFSEP), Lyon, France.
3
ReLSEP, Lorraine Register of MS, EA 4360, Department of Neurology, CHU Nancy, Nancy, France.
4
Department of Neurology, CHU Toulouse, Toulouse, France.
5
Department of Neurology, CHU Bordeaux, Bordeaux, France.
6
Department of Neurology, Hopitaux Universitaire de Strasbourg, Clinical investigation center (CIC INSERM 1434) and UMR INSERM 1119/Federation de Medecine translationnelle (FMTS), Strasbourg, France.
7
Université de Lille, Department of Neurology, Hôpital Roger Salengro, CHRU de Lille, Lille, France.
8
Department of Neurology, CHU Caen, Caen, France.
9
Department of Neurology, CHU Nice, Nice, France.
10
Department of Neurology, CHU Dijon, Dijon, France.
11
Department of Neurology, CHU Clermont-Ferrand, Clermont-Ferrand, France.
12
APHM, Hôpital de La Timone, Pôle de Neurosciences Cliniques, Department of Neurology, Marseille, France.
13
Department of Neurology, CHU Besançon, Besançon, France.
14
Department of Neurology, CHU de Martinique, Martinique, France.
15
Department of Neurology, CHU Saint-Etienne, Saint-Etienne, France.
16
Department of Epidemiology, EHESP Rennes, Sorbonne Paris Cité, Paris, France.
17
Department of Neurology, CHU Lyon, Lyon, France.
18
Department of Neurology, CHU Rennes, WEst Neuroscience Network of Excellence (WENNE), Rennes, France.

Abstract

BACKGROUND:

Recent studies in multiple sclerosis (MS) showed longer survival times from clinical onset than older hospital-based series. However estimated median time ranges widely, from 24 to 45 years, which makes huge difference for patients as this neurological disease mainly starts around age 20 to 40. Precise and up-to-date reference data about mortality in MS are crucial for patients and neurologists, but unavailable yet in France.

OBJECTIVES:

Estimate survival in MS patients and compare mortality with that of the French general population.

METHODS:

We conducted a multicenter observational study involving clinical longitudinal data from 30,413 eligible patients, linked to the national deaths register. Inclusion criteria were definite MS diagnosis and clinical onset prior to January, 1st 2009 in order to get a minimum of 1-year disease duration.

RESULTS:

After removing between-center duplicates and applying inclusion criteria, the final population comprised 27,603 MS patients (F/M sex ratio 2.5, mean age at onset 33.0 years, 85.5% relapsing onset). During the follow-up period (mean 15.2 +/- 10.3 years), 1569 deaths (5.7%) were identified; half related to MS. Death rates were significantly higher in men, patients with later clinical onset, and in progressive MS. Overall excess mortality compared with the general population was moderate (Standardized Mortality Ratio 1.48, 95% confidence interval [1.41-1.55]), but increased considerably after 20 years of disease (2.20 [2.10-2.31]).

CONCLUSIONS:

This study revealed a moderate decrease in life expectancy in MS patients, and showed that the risk of dying is strongly correlated to disease duration and disability, highlighting the need for early actions that can slow disability progression.

PMID:
26148099
PMCID:
PMC4492994
DOI:
10.1371/journal.pone.0132033
[Indexed for MEDLINE]
Free PMC Article

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