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      • Record: found
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      Effect of comorbidity on mortality in multiple sclerosis

      research-article
      Author(s): , MD, PhD , , MD, MSc, , MD, MSc, , MD, , MD, PhD, , MSc, , MD, PhD
      Publication date PMC-release:
      Journal: Neurology
      Publisher: Lippincott Williams & Wilkins

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          Abstract

          Objective:

          We aimed to compare survival in the multiple sclerosis (MS) population with a matched cohort from the general population, and to evaluate the association of comorbidity with survival in both populations.

          Methods:

          Using population-based administrative data, we identified 5,797 persons with MS and 28,807 controls matched on sex, year of birth, and region. We estimated annual mortality rates. Using Cox proportional hazards regression, we evaluated the association between comorbidity status and mortality, stratifying by birth cohort, and adjusting for sex, socioeconomic status, and region. We compared causes of death between populations.

          Results:

          Median survival from birth in the MS population was 75.9 years vs 83.4 years in the matched population. MS was associated with a 2-fold increased risk of death (adjusted hazard ratio 2.40; 95% confidence interval: 2.24–2.58). Several comorbidities were associated with increased hazard of death in both populations, including diabetes, ischemic heart disease, depression, anxiety, and chronic lung disease. The magnitude of the associations of mortality with chronic lung disease, diabetes, hypertension, and ischemic heart disease was lower in the MS population than the matched population. The most common causes of death in the MS population were diseases of the nervous system and diseases of the circulatory system. Mortality rates due to infectious diseases and diseases of the respiratory system were higher in the MS population.

          Conclusion:

          In the MS population, survival remained shorter than expected. Within the MS population, comorbidity was associated with increased mortality risk. However, comorbidity did not preferentially increase mortality risk in the MS population as compared with controls.

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          Most cited references28

          • Record: found
          • Abstract: found
          • Article: not found

          Comorbidity delays diagnosis and increases disability at diagnosis in MS.

          R. Marrie, D Campagnolo, G. Cutter … (2009)
          Comorbidity is common in the general population and is associated with adverse health outcomes. In multiple sclerosis (MS), it is unknown whether preexisting comorbidity affects the delay between initial symptom onset and diagnosis ("diagnostic delay") or the severity of disability at MS diagnosis. Using the North American Research Committee on Multiple Sclerosis Registry, we assessed the association between comorbidity and both the diagnostic delay and severity of disability at diagnosis. In 2006, we queried participants regarding physical and mental comorbidities, including date of diagnosis, smoking status, current height, and past and present weight. Using multivariate Cox regression, we compared the diagnostic delay between participants with and without comorbidity at diagnosis. We classified participants enrolled within 2 years of diagnosis (n = 2,375) as having mild, moderate, or severe disability using Patient Determined Disease Steps, and assessed the association of disability with comorbidity using polytomous logistic regression. The study included 8,983 participants. After multivariable adjustment for demographic and clinical characteristics, the diagnostic delay increased if obesity, smoking, or physical or mental comorbidities were present. Among participants enrolled within 2 years of diagnosis, the adjusted odds of moderate as compared to mild disability at diagnosis increased in participants with vascular comorbidity (odds ratio [OR] 1.51, 95% CI 1.12-2.05) or obesity (OR 1.38, 95% CI 1.02-1.87). The odds of severe as compared with mild disability increased with musculoskeletal (OR 1.81, 95% CI 1.25-2.63) or mental (OR 1.62, 95% CI 1.23-2.14) comorbidity. Both diagnostic delay and disability at diagnosis are influenced by comorbidity. The mechanisms underlying these associations deserve further investigation.
          Article 0 comments Cited 90 times – based on 0 reviews     Review now
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            Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis.

            Hyon Choi, D Ang, Frederick Wolfe … (2005)
            Whether comorbid depression increases mortality in patients with rheumatoid arthritis (RA) is unknown. Our objective was to determine whether the presence of depression predicted mortality in patients with RA. We followed 1290 consecutive outpatients with RA who met our stringent inclusion criteria during an 18-year observation period. Since 1981, demographic, clinic, and self-report data were collected and entered into a computer database at the time of each clinic visit. The comorbidity data were consistently recorded beginning in 1991. Our primary independent variable was the mean of the Arthritis Impact Measurement Scales (AIMS) depression scores during the first 4 years of entry into the clinic cohort (average 4-year depression). Data were analyzed using Cox proportional hazard models. After adjusting for covariates, the hazard ratio (HR) for each unit increase in the average 4-year depression score on mortality was 1.14 (p or = 4 is consistent with clinical depression, we analyzed the dataset using the average 4-year depression score as a dichotomous variable (score or = 4). The HR of clinical depression on mortality was 2.2 (95% CI 1.2- 3.9, p = 0.01). Depression increases the risk of mortality in RA. Our study highlights the importance of comorbid depression in patients with RA.
            Article 0 comments Cited 70 times – based on 0 reviews     Review now
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              Trends in survival and cause of death in Danish patients with multiple sclerosis.

              Henrik Brønnum-Hansen, Nils Koch-Henriksen, Egon Stenager (2004)
              The Danish Multiple Sclerosis Registry contains information about all Danish patients in whom multiple sclerosis has been diagnosed since 1948. The purpose of this study was to analyse trends in survival and causes of death of these patients and to compare them with those of the general population. The study comprised all patients with onset in the period 1949-1996. All case records were validated and classified according to standardized diagnostic criteria. Data on emigration and death were obtained by record linkage to official registers. The end of follow-up was 1 January 2000 for emigration and death, and 1 January 1999 for cause-specific deaths. Standardized mortality ratios and excess death rates were calculated for various causes of death and periods after multiple sclerosis onset, and time trends in survival probability were analysed by Cox regression. The study comprised 9881 patients, of whom 4254 had died before end of follow-up. The median survival time from onset was approximately 10 years shorter for multiple sclerosis patients than for the age-matched general population, and multiple sclerosis was associated with an almost threefold increase in the risk for death. According to death certificates, more than half (56.4%) of the patients had died from multiple sclerosis. They also had excess mortality rates from other diseases, except cancer, and from accidents and suicide. The probability for survival improved significantly during the observation period. Thus, the 10-year excess mortality was almost halved in comparison with that in the middle of the 1900s.
              Article 0 comments Cited 70 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ruth Ann Marrie:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. Neurology, Editorial Board Multiple Sclerosis Journal, Editorial Board

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. Received support as site Principal Investigator for clinical trials from Sanofi-Aventis (2007-2014)

                Research Support, Government Entities:

                1. Received support as principal investigator from the Canadian Institutes of Health Research (2010-2019), the Public Health Agency of Canada (2010-2013), and Research Manitoba (2014-2019).

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. Received support as principal investigator from Multiple Sclerosis Society of Canada (2009-2016) and the National Multiple Sclerosis Society (2013-2014), and as co-principal investigator from Multiple Sclerosis Scientific Foundation (2009-2015). Received support from Consortium of Multiple Sclerosis Centers (2004-2009, 2011-2014).

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Lawrence Elliott:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. (1) Canadian Institutes for Health Research, “Reducing inequities in access to and use of prenatal care in the Winnipeg Health Region through health system improvement”, Co-Investigator, (M. Heaman PI), 2012-2015 (2) Canadian Institutes for Health Research, “Developing a diabetes prevention intervention: Identifying and targeting contextually-relevant stressors”, Co- Investigator, (S. Bruce PI), 2012-2015

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. (1) Multiple Sclerosis Society of Canada, The Impact of Comorbidity and Secular Time on Hospitalizations and Mortality in MS, Co-Investigator (RA Marrie PI), 2012-2014

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                James Marriott:
                Comment :

                Scientific Advisory Boards:

                1. Served on a scientific advisory board for Roche (2012, 2014).

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. International Journal of MS Care, editorial board member, 2011-

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. (1) Multiple Sclerosis Society of Canada, (2) Consortium of MS Centers, (3) Manitoba Medical Service Foundation

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Michael Cossoy:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for travel or speaker honoraria:

                1. EMD Serono Canada: travel and honorarium for participation as faculty for a neurology resident review course for the Royal College of Physicians and Surgeons of Canada Specialty Examination

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. Diagnostic Services Manitoba, Primary Investigator, 2010- 2012

                Research Support, Academic Entities:

                1. University Research Grants Program (University of Manitoba), Primary Investigator, 2010-2011

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                James Blanchard:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. 1) CIHR MOP-123575 - PI, 01/10/12-30/09/15

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. 1) BMGF #OPPGG5310 - PI, 04/11/09-30/09/15 2) BMGF #OPP1032367 - PI, 07/11/11/-30/09/15 3) BMGF #OPP1084474 - PI, 15/11/13-31/10/16

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Stella Leung:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. NONE

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Nancy Yu:
                Comment :

                Scientific Advisory Boards:

                1. NONE

                Gifts:

                1. NONE

                Funding for Travel or Speaker Honoraria:

                1. NONE

                Editorial Boards:

                1. NONE

                Patents:

                1. NONE

                Publishing Royalties:

                1. NONE

                Employment, Commercial Entity:

                1. NONE

                Consultancies:

                1. NONE

                Speakers' Bureaus:

                1. NONE

                Other Activities:

                1. NONE

                Clinical Procedures or Imaging Studies:

                1. NONE

                Research Support, Commercial Entities:

                1. NONE

                Research Support, Government Entities:

                1. NONE

                Research Support, Academic Entities:

                1. NONE

                Research Support, Foundations and Societies:

                1. CIHR ($2,498,495, 2013/4 - 2018/3), Advancing primary healthcare for persons living with HIV in Canada, co- investigator, PI Dr. Clare Liddy. Multiple Sclerosis Society of Canada ($155,599, 2012/7 - 2015/6), The impact of comorbidity and secular time on hospitalizations and mortality in MS, co-investigator, PI Dr. Ruth Ann Marrie. National Multiple Sclerosis Society ($317,843, 2012/7- 2015/6), Adherence to immunomodulators in Multiple Sclerosis: prevalence and clinical impact (the AIMS Study), collaborator, PI Dr. Helen Tremlett. CIHR Emerging Team Grant ($1,500,000, 2010/4 - 2015/3), Team in the epidemiology & impact of comorbidity on MS (ECoMS), co-investigator, PI Dr. Ruth Ann Marie. Gilead Sciences ($96,000, 2013/4 - 2014/3). Missed opportunities for diagnosis for HIV epidemiological study (MODES Manitoba), co-investigator, PI Dr. Marissa Becker. CIDA(International development grant, $20,000), Building capacity to respond to HIV/AIDS in China: Extending the impact. Co-investigator, PI Dr. James Blanchard. CIHR Emerging Team: HIV/AIDS vaccine discovery and social research ($750,000), Team in the socio-cultural aspects of implementing HIV vaccine programs among MSM and FSWs in Asia and Africa. co-investigator, PI Dr. Robert Lorway. CIDA (International development grant, $990,000), Capacity building to respond to HIV/AIDS in China. Co- investigator, PI Dr. James Blanchard.

                Stock/Stock Options/Board of Directors Compensation:

                1. NONE

                License Fee Payments, Technology or Inventions:

                1. NONE

                Royalty Payments, Technology or Inventions:

                1. NONE

                Stock/Stock Options, Research Sponsor:

                1. NONE

                Stock/Stock Options, Medical Equipment & Materials:

                1. NONE

                Legal Proceedings:

                1. NONE

                Journal
                Journal ID (nlm-ta): Neurology
                Journal ID (iso-abbrev): Neurology
                Journal ID (hwp): neurology
                Journal ID (publisher-id): neur
                Journal ID (pmc): neurology
                Journal ID (publisher-id): NEUROLOGY
                Title: Neurology
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Print): 0028-3878
                ISSN (Electronic): 1526-632X
                Publication date (Print): 21 July 2015
                Publication date PMC-release: 21 July 2015
                Volume: 85
                Issue: 3
                Pages: 240-247
                Affiliations
                From the Departments of Internal Medicine (R.A.M., J.M., M.C.) and Community Health Sciences (R.A.M., L.E., J.B., S.L., N.Y.), University of Manitoba, Winnipeg; Epidemiology and Surveillance (N.Y.), Public Health and Primary Care Division, Manitoba Health, Winnipeg, Canada.
                Author notes
                Correspondence to Dr. Marrie: rmarrie@ 123456hsc.mb.ca

                Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. The Article Processing Charge was paid by an operating grant from the MS Society of Canada.

                Article
                Publisher ID: NEUROLOGY2014629253
                DOI: 10.1212/WNL.0000000000001718
                PMC ID: 4516290
                PubMed ID: 26019190
                SO-VID: fe7c67de-78d3-4152-827d-e99fc1ed14e8
                Copyright © © 2015 American Academy of Neurology
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.

                History
                Date received : 07 November 2014
                Date accepted : 19 March 2015
                Categories
                Subject: 41
                Subject: 52
                Subject: Article
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                OPEN-ACCESS TRUE

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