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Survival and Cause of death in multiple sclerosis: A prospective population based study
  1. Claire L Hirst (clairehirst_uk{at}
  1. University Hospital of Wales, United Kingdom
    1. Robert Swingler (robert.swingler{at}
    1. Ninewells Hospital, United Kingdom
      1. Alastair Compston (alastair.compston{at}
      1. Addenbrookes Hospital, United Kingdom
        1. Yoav Ben-Shlomo (y.ben-shlomo{at}
        1. University of Bristol, United Kingdom
          1. Neil P Robertson (robertsonnp{at}
          1. University Hospital of Wales, United Kingdom


            Background:Detailed studies of mortality in MS are limited. Studying death certificates in a prospective cohort of patients known to have MS is of value in establishing mortality data and can also provides important information on the accuracy and utility of death certificates for epidemiological studies.

            Methods:A population-based survey performed in South Wales in 1985 identified 441 patients. Cases were flagged with the Office of Population Censuses and Surveys and death certificates collected prospectively for more than 20 years.

            Results:Median observed survival time was 38.0 years from symptom onset. Mean age at death for females was 65.3 and for males 65.2 years. Mean age at death in patients dying from MS related causes was 62.5 and 69.3 years (p<0.001) for unrelated deaths. Those dying of MS related causes had a younger age at disease onset (32.5) compared to those dying of unrelated causes (36.8 years) (p=0.01). Cause of death was related to MS in 57.9% and unrelated in 42.1%. In 27% of patients “MS” was absent from the death certificate. The commonest cause of death was respiratory disease (47.5%). The standardised mortality ratio was 2.79 (95% CI 2.44, 3.18) so that MS cases were almost three times more likely to die relatively than the general population.

            Conclusions:These results confirm a continuing trend of premature death in patients with MS. Relying upon data derived from death certificates will underestimate disease prevalence. Differences were identified between those dying from MS related causes and those dying from other causes.

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