Contributions
Abstract: P353
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Natural course
Introduction: People with MS have increased mortality, compared to the general population, but only half, on average, die from causes directly related to the disease.
Methods: Among 324 dead patients from the London Ontario database (PP = 111; RR = 20; SP = 193), we used Kaplan Meier and Cox regression analyses to explore factors, affecting mortality and causes of death.
Results: The median time to death from onset was 24 years and the median age at death was 60 years. The majority of patients (n=210; 64.8%) died from causes related to MS; respiratory diseases (n=116; 55.2%), MS (n=48; 22.8%) and infections (n = 19; 9%) were the commonest immediate causes of death. In the group of dead from causes unrelated to MS (n=114; 35.2%) most of patients died from malignancies (n=42; 36.8%), cardiovascular (n=31; 27.1%) and cerebrovascular (n=15; 13.1%) diseases. In the two subgroups, of dead due and not due to MS, the distribution of disease phenotypes (relapsing onset patients: 65.7% vs 65.8%; p=0.98), sex ratio (females: 57.6% vs 56.1%; p=0.79) and disability at last assessment (median DSS = 8 in both subgroup) were similar. Those who died from causes related to MS were younger at the disease onset (33.0 vs 36.7 mean years; p=0.03), attained death in similar time (23.9 versus 26.0 mean years; p=0.075) and were younger at death (57.0 versus 62.7 mean years; p< 0.001). Therefore, older age at onset associated with a higher probability of dying from MS unrelated causes (OR=1.04; p=0.004), as patients grew older and were exposed to a higher risk of developing comorbidities, such as malignancies, cardiovascular and cerebrovascular diseases. Among the dead due to MS, the time to death was not affected by sex, the clinical phenotype, the age at onset or by the type of symptoms at clinical presentation. In contrast, among the dead not due to MS, time to death was shorter in males (males=23.3, females=28.1 mean years; p=0.03), in those with a PP course (PP=21.9 versus RR/SP=28.2 mean years; p=0.02) and in those older at onset (age ≤ 20 = 30.7, age 21-30 = 31.0, age > 30 = 23.9 mean years, p = 0.02).
Conclusions: Dead due and not due to MS have similar disease duration and disability immediately preceding death, but differ in the age at clinical onset, which is associated with different death causes. These data question the validity of differentiating whether death is directly related to MS or not, and the utility of using DSS 10 as MS-specific landmark status.
Disclosure: Antonio Scalfari: nothing to disclose
Christian Lederer: nothing to disclose
Martin Daumer: nothing to disclose
Richard Nicholas: nothing to disclose
George Ebers: nothing to disclose
Paolo Muraro: nothing to disclose
Abstract: P353
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Natural course
Introduction: People with MS have increased mortality, compared to the general population, but only half, on average, die from causes directly related to the disease.
Methods: Among 324 dead patients from the London Ontario database (PP = 111; RR = 20; SP = 193), we used Kaplan Meier and Cox regression analyses to explore factors, affecting mortality and causes of death.
Results: The median time to death from onset was 24 years and the median age at death was 60 years. The majority of patients (n=210; 64.8%) died from causes related to MS; respiratory diseases (n=116; 55.2%), MS (n=48; 22.8%) and infections (n = 19; 9%) were the commonest immediate causes of death. In the group of dead from causes unrelated to MS (n=114; 35.2%) most of patients died from malignancies (n=42; 36.8%), cardiovascular (n=31; 27.1%) and cerebrovascular (n=15; 13.1%) diseases. In the two subgroups, of dead due and not due to MS, the distribution of disease phenotypes (relapsing onset patients: 65.7% vs 65.8%; p=0.98), sex ratio (females: 57.6% vs 56.1%; p=0.79) and disability at last assessment (median DSS = 8 in both subgroup) were similar. Those who died from causes related to MS were younger at the disease onset (33.0 vs 36.7 mean years; p=0.03), attained death in similar time (23.9 versus 26.0 mean years; p=0.075) and were younger at death (57.0 versus 62.7 mean years; p< 0.001). Therefore, older age at onset associated with a higher probability of dying from MS unrelated causes (OR=1.04; p=0.004), as patients grew older and were exposed to a higher risk of developing comorbidities, such as malignancies, cardiovascular and cerebrovascular diseases. Among the dead due to MS, the time to death was not affected by sex, the clinical phenotype, the age at onset or by the type of symptoms at clinical presentation. In contrast, among the dead not due to MS, time to death was shorter in males (males=23.3, females=28.1 mean years; p=0.03), in those with a PP course (PP=21.9 versus RR/SP=28.2 mean years; p=0.02) and in those older at onset (age ≤ 20 = 30.7, age 21-30 = 31.0, age > 30 = 23.9 mean years, p = 0.02).
Conclusions: Dead due and not due to MS have similar disease duration and disability immediately preceding death, but differ in the age at clinical onset, which is associated with different death causes. These data question the validity of differentiating whether death is directly related to MS or not, and the utility of using DSS 10 as MS-specific landmark status.
Disclosure: Antonio Scalfari: nothing to disclose
Christian Lederer: nothing to disclose
Martin Daumer: nothing to disclose
Richard Nicholas: nothing to disclose
George Ebers: nothing to disclose
Paolo Muraro: nothing to disclose