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Thread: (Abstract) Excess mortality among MS patients in Denmark fell over last 6 decades

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    Default (Abstract) Excess mortality among MS patients in Denmark fell over last 6 decades

    Recent studies have seemed to show a decline in MS mortality rates since the use of disease-modifying drugs (DMDs) but this study of 18,847 Danish MS patients between 1950 and 1999 shows that that decline actually began before the DMDs came along.

    In the abstract below, SMR (standardized mortality ratio) = Standardized Mortality Ratio (SMR) is a ratio between the observed number of deaths in an study population and the number of deaths would be expected, based on the age- and sex-specific rates in a standard population and the age and sex distribution of the study population.


    From PubMed, July 15, 2017:


    J Neurol Neurosurg Psychiatry. 2017 Aug;88(8):626-631.


    Excess mortality among patients with multiple sclerosis in Denmark has dropped significantly over the past six decades: a population based study


    Koch-Henriksen N1,2, Laursen B3, Stenager E2,4, Magyari M2,5.


    Author information


    Department of Clinical Epidemiology, Clinical Institute, University of Aarhus, Aarhus, Denmark.
    2
    The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    3
    National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
    4
    Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    5
    Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.


    BACKGROUND:


    Lifetime expectancy in multiple sclerosis (MS) is reduced. Few studies have had sufficient follow-up or sufficient number of patients to assess if survival has improved with time. However, a recent meta-analysis found no time-dependent change in MS excess mortality across studies over recent decades.


    OBJECTIVE:


    To investigate whether short-term all-cause excess mortality in patients with MS in the total Danish population has changed over the last six decades.


    PATIENTS AND METHODS:


    We included all patients with MS recorded in the nationwide Danish MS Registry with definite or probable MS and onset from 1950 through 1999. The Danish Civil Registration System provided dates of death for all deceased patients with follow-up in 2015, and Statistics Denmark supplied specific population mortality. We calculated excess number of death per 1000 person-years (EDR) and standardised mortality ratio (SMR).


    RESULTS:


    We included 18,847 patients among whom 6102 had died as opposed to 2492 expected deaths. EDR was 10.63 (95% CI 10.19 to 11.09) and a SMR was 2.45 (95% CI 2.39 to 2.51). The 15-year EDR dropped gradually from 11.29 (95% CI 9.95 to 12.73) in the 1950-1959 onset cohort to 2.56 (95% CI 1.98 to 3.18) in the 1990-1999 onset cohort, and SMR dropped from 4.48 (95% CI 4.06 to 4.92) to 1.80 (95% CI 1.62 to 1.99).


    CONCLUSION:


    The decline in short-term excess mortality in MS started decades before disease-modifying treatment of MS became available, before use of MRI became widespread, and before the McDonald diagnostic criteria were introduced. A change in the MS cohorts with fewer malignant cases may be a significant contributor.

    The abstract can be seen here.
    Last edited by agate; 07-16-2017 at 10:37 AM.
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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