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February 25, 2020; 94 (8) Article

Multiple cause of death analysis in multiple sclerosis

A population-based study

Katharine Harding, Feng Zhu, Mohammed Alotaibi, Thomas Duggan, Helen Tremlett, Elaine Kingwell
First published January 13, 2020, DOI: https://doi.org/10.1212/WNL.0000000000008907
Katharine Harding
From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia.
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Feng Zhu
From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia.
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Mohammed Alotaibi
From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia.
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Thomas Duggan
From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia.
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Helen Tremlett
From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia.
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Elaine Kingwell
From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia.
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Multiple cause of death analysis in multiple sclerosis
A population-based study
Katharine Harding, Feng Zhu, Mohammed Alotaibi, Thomas Duggan, Helen Tremlett, Elaine Kingwell
Neurology Feb 2020, 94 (8) e820-e829; DOI: 10.1212/WNL.0000000000008907

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Abstract

Objective To gain a better understanding of the complex patterns of causes that contribute to death due to multiple sclerosis (MS) by assessing the relationship between MS and other causes of death listed on death certificates.

Methods Multiple cause of death data for all adult deaths (aged ≥18 years) in British Columbia, Canada, between 1986 and 2013 were accessed. All causes, as listed on the death certificate, whether underlying or contributing, were considered “any mention” causes. The associations between mention of MS on the death certificate and mention of other causes of death were examined by logistic regression, adjusted for age, sex, and calendar year (Bonferroni-corrected α level = 0.002). Findings were also sex-stratified.

Results Among 771,288 deaths, MS was mentioned on 2,153 certificates. If MS was mentioned (versus not mentioned), there was a greater chance that specific conditions contributed to the death: respiratory infection (adjusted odds ratio [aOR], 3.03 [95% confidence interval (CI), 2.73–3.36]), aspiration pneumonia (aOR, 7.15 [95% CI, 6.23–8.22]), urinary tract infection (UTI) (aOR, 10.2 [95% CI, 8.7–12.0]), other infection including sepsis (aOR, 1.34 [95% CI, 1.15–1.56]), and skin disease (aOR, 5.06 [95% CI, 3.96–6.46]). Sex differences existed for urinary tract infection (men: aOR, 14.9 [95% CI, 11.5–19.3]; women: aOR, 8.00 [95% CI, 6.53–9.81]) and chronic respiratory disease (men = aOR, 1.36 [95% CI, 1.14–1.63]; women = aOR, 0.97 [95% CI, 0.84–1.13]).

Conclusions Deaths attributed to MS were commonly caused by infection (especially respiratory and urinary tract–related); conditions associated with advanced disability and immobility, such as aspiration pneumonia; and chronic respiratory disease in men. All are potentially modifiable; interventions that reduce the frequency or severity of these complications could improve survival in MS.

Glossary

aOR=
adjusted odds ratio;
CI=
confidence interval;
ICD=
International Classification of Diseases;
MCOD=
multiple cause of death;
MS=
multiple sclerosis;
OR=
odds ratio

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received March 27, 2019.
  • Accepted in final form August 8, 2019.
  • © 2020 American Academy of Neurology
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