title: Causes of death among commercially insured multiple sclerosis patients in the United States.
abstract: BACKGROUND
  Information on causes of death (CODs) for patients with multiple sclerosis (MS) in the United States is sparse and limited by standard categorizations of underlying and immediate CODs on death certificates. Prior research indicated that excess mortality among MS patients was largely due to greater mortality from infectious, cardiovascular, or pulmonary causes.
  
  
  OBJECTIVE
  To analyze disease categories in order to gain insight to pathways, which lead directly to death in MS patients.
  
  
  METHODS
  Commercially insured MS patients enrolled in the OptumInsight Research database between 1996 and 2009 were matched to non-MS comparators on age/residence at index year and sex. The cause most-directly leading to death from the death certificate, referred to as the "principal" COD, was determined using an algorithm to minimize the selection of either MS or cardiac/pulmonary arrest as the COD. Principal CODs were categorized into MS, cancer, cardiovascular, infectious, suicide, accidental, pulmonary, other, or unknown. Infectious, cardiovascular, and pulmonary CODs were further subcategorized.
  
  
  RESULTS
  30,402 MS patients were matched to 89,818 controls, with mortality rates of 899 and 446 deaths/100,000 person-years, respectively. Excluding MS, differences in mortality rate between MS patients and non-MS comparators were largely attributable to infections, cardiovascular causes, and pulmonary problems. Of the 95 excessive deaths (per 100,000 person-years) related to infectious causes, 41 (43.2%) were due to pulmonary infections and 45 (47.4%) were attributed to sepsis. Of the 46 excessive deaths (per 100,000 person-years) related to pulmonary causes, 27 (58.7%) were due to aspiration. No single diagnostic entity predominated for the 60 excessive deaths (per 100,000 person-years) attributable to cardiac CODs.
  
  
  CONCLUSIONS
  The principal COD algorithm improved on other methods of determining COD in MS patients from death certificates. A greater awareness of the common CODs in MS patients will allow physicians to anticipate potential problems and, thereby, improve the care that they provide.
authors.affiliation: Department of Neurology, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Goodin
authors.affiliation: Slone Epidemiology Center at Boston University, Boston, Massachusetts, United States of America; Care-Safe, Boston, Massachusetts, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Corwin
authors.affiliation: Slone Epidemiology Center at Boston University, Boston, Massachusetts, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Kaufman
authors.affiliation: Care-Safe, Boston, Massachusetts, United States of America.
authors.forename: Howard
authors.initials: H
authors.lastname: Golub
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, United States of America.
authors.forename: Shoshana
authors.initials: S
authors.lastname: Reshef
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, United States of America.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Rametta
authors.affiliation: Teva Pharmaceuticals, Frazer, Pennsylvania, United States of America, Department of Neurology, Heinrich Heine University, Dusseldorf, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Knappertz
authors.affiliation: University of Alabama School of Public Health, Birmingham, Alabama, United States of America.
authors.forename: Gary
authors.initials: G
authors.lastname: Cutter
authors.affiliation: Myelo Therapeutics GmbH, Berlin, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Pleimes
mesh_terms: D000328:Adult; D002423:Cause of Death; D003644:Death Certificates; D005260:Female; D006801:Humans; D007341:Insurance / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology