Journal
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
Volume 83, Issue 1, Pages 61-66Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/jnnp-2011-300616
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Funding
- Canadian Institutes of Health Research [MOP-82738]
- Multiple Sclerosis Society of Canada
- Canadian Institute of Health Research [MOP-93646]
- National Multiple Sclerosis Society [RG 4202-A-2]
- National Multiple Sclerosis Society
- Christopher Foundation (Vancouver)
- University of British Columbia
- Canada Research Chair for Neuroepidemiology and Multiple Sclerosis
- MS Society of Canada
- US National MS Society
- MS/MRI Research Group
- endMS Research and Training Network
- European Committee for Treatment and Research in Multiple Sclerosis
- Aspreva
- Aventis
- Bayer
- Biogen-Idec
- BioMS
- Corixa
- Genentech
- Novartis
- Serono
- Talecris
- Teva-neurosciences
- Biogen Idec
- UK MS Trust
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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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