Contributions
Abstract: P301
Type: Poster
Abstract Category: Clinical aspects of MS - Natural course
Background: Several studies have investigated the mortality of patients with MS compared with controls or population, but trends in survival are poorly described.
Objective: To investigate trends in excess all-cause mortality of MS patients over the last 60 years in Denmark.
Methods: The nationwide population-based Danish MS Registry has at an almost complete level collected information on all Danish citizens with onset of MS since 1948. The Danish national registers and, since 1968, the Civil Registration System have provided complete follow-up of vital status for all individuals. The study included all Danish MS patients with onset 1950-1999 with follow-up in 2015. Five ten-year onset cohorts from 1950-1959 to 1990-1999 were included. Expected numbers of deaths were calculated from sex, age, and calendar year-specific population life tables provided by Statistics Denmark. Analyses were right truncated at 15 years after onset for comparison between the cohorts. Excess mortality was calculated as standardized mortality ratio (SMR), that is, observed/expected number of deaths. Test for trends was done by linear regression weighted by number of deceased patients in each onset cohort.
Results: 14,196 MS cases were followed. The observed number of deaths within 15 years from onset was 1,727. The 15-year SMRs (with 95% CI) were for the 1950-1959-onset cohort 4.27 (3.87-4.70); for the 1960-1969-onset cohort 3.41 (3.03-3.82); for the 1970-1979-onset cohort 2.61 (2.33-2.93); for the 1980-1989-onset cohort 2.30 (2.06-2.56); and for the 1990-1999-onset cohort 1.96 (1.76-2.17), while the mean age of onset increased from 33 to 36 years through the cohorts. The test for trend showed a significant decrease of SMR of -0.579 per decade (95% CI −0.72; −0.44 p = 0.0042). There was no significant difference in the trend between the two sexes.
Conclusion: In this 60-year population based study we found that the all-cause excess mortality in the first 15 years after clinical onset has dropped significantly in MS patients over the years since 1950, but they still live shorter than an age and sex matched background population The decrease in mortality with time surpasses that of the population. Excess mortality started to decrease already decades before disease modifying drugs became available. It may be attributed to milder disease in recent onset cohorts, improvement of care, or better treatment of life-threatening comorbidities and complications.
Disclosure:
N. Koch-Henriksen has received honoraria for lecturing and participation in advisory councils, travel expenses for attending congresses and meetings, and financial support for monitoring the Danish MS Treatment Register from Bayer-Schering, Merck-Serono, BiogenIdec, TEVA, Sanofi-Avensis, and Novartis.
M. Magyari has served on scientific advisory board for BiogenIdec and TEVA and has received honoraria for lecturing from BiogenIdec, MerckSerono, Sanofi-Aventis, and Teva. She has received support for congress participation from BiogenIdec, MerckSerono, Novartis, and Genzyme.
Bjarne Lauersen has nothing to disclose
Abstract: P301
Type: Poster
Abstract Category: Clinical aspects of MS - Natural course
Background: Several studies have investigated the mortality of patients with MS compared with controls or population, but trends in survival are poorly described.
Objective: To investigate trends in excess all-cause mortality of MS patients over the last 60 years in Denmark.
Methods: The nationwide population-based Danish MS Registry has at an almost complete level collected information on all Danish citizens with onset of MS since 1948. The Danish national registers and, since 1968, the Civil Registration System have provided complete follow-up of vital status for all individuals. The study included all Danish MS patients with onset 1950-1999 with follow-up in 2015. Five ten-year onset cohorts from 1950-1959 to 1990-1999 were included. Expected numbers of deaths were calculated from sex, age, and calendar year-specific population life tables provided by Statistics Denmark. Analyses were right truncated at 15 years after onset for comparison between the cohorts. Excess mortality was calculated as standardized mortality ratio (SMR), that is, observed/expected number of deaths. Test for trends was done by linear regression weighted by number of deceased patients in each onset cohort.
Results: 14,196 MS cases were followed. The observed number of deaths within 15 years from onset was 1,727. The 15-year SMRs (with 95% CI) were for the 1950-1959-onset cohort 4.27 (3.87-4.70); for the 1960-1969-onset cohort 3.41 (3.03-3.82); for the 1970-1979-onset cohort 2.61 (2.33-2.93); for the 1980-1989-onset cohort 2.30 (2.06-2.56); and for the 1990-1999-onset cohort 1.96 (1.76-2.17), while the mean age of onset increased from 33 to 36 years through the cohorts. The test for trend showed a significant decrease of SMR of -0.579 per decade (95% CI −0.72; −0.44 p = 0.0042). There was no significant difference in the trend between the two sexes.
Conclusion: In this 60-year population based study we found that the all-cause excess mortality in the first 15 years after clinical onset has dropped significantly in MS patients over the years since 1950, but they still live shorter than an age and sex matched background population The decrease in mortality with time surpasses that of the population. Excess mortality started to decrease already decades before disease modifying drugs became available. It may be attributed to milder disease in recent onset cohorts, improvement of care, or better treatment of life-threatening comorbidities and complications.
Disclosure:
N. Koch-Henriksen has received honoraria for lecturing and participation in advisory councils, travel expenses for attending congresses and meetings, and financial support for monitoring the Danish MS Treatment Register from Bayer-Schering, Merck-Serono, BiogenIdec, TEVA, Sanofi-Avensis, and Novartis.
M. Magyari has served on scientific advisory board for BiogenIdec and TEVA and has received honoraria for lecturing from BiogenIdec, MerckSerono, Sanofi-Aventis, and Teva. She has received support for congress participation from BiogenIdec, MerckSerono, Novartis, and Genzyme.
Bjarne Lauersen has nothing to disclose