title: Survival in commercially insured multiple sclerosis patients and comparator subjects in the U.S.
abstract: OBJECTIVE
  Compare survival in patients with multiple sclerosis (MS) from a U.S. commercial health insurance database with a matched cohort of non-MS subjects.
  
  
  METHODS
  30,402 MS patients and 89,818 non-MS subjects (comparators) in the OptumInsight Research (OIR) database from 1996 to 2009 were included. An MS diagnosis required at least 3 consecutive months of database reporting, with two or more ICD-9 codes of 340 at least 30 days apart, or the combination of 1 ICD-9-340 code and at least 1 MS disease-modifying treatment (DMT) code. Comparators required the absence of ICD-9-340 and DMT codes throughout database reporting. Up to three comparators were matched to each patient for: age in the year of the first relevant code (index year - at least 3 months of reporting in that year were required); sex; region of residence in the index year. Deaths were ascertained from the National Death Index and the Social Security Administration Death Master File. Subjects not identified as deceased were assumed to be alive through the end of 2009.
  
  
  RESULTS
  Annual mortality rates were 899/100,000 among MS patients and 446/100,000 among comparators. Standardized mortality ratios compared to the U.S. population were 1.70 and 0.80, respectively. Kaplan-Meier analysis yielded a median survival from birth that was 6 years lower among MS patients than among comparators.
  
  
  CONCLUSIONS
  The results show, for the first time in a U.S. population, a survival disadvantage for contemporary MS patients compared to non-MS subjects from the same healthcare system. The 6-year decrement in lifespan parallels a recent report from British Columbia.
authors: Slone Epidemiology Center at Boston University, 1010 Commonwealth Avenue, Boston, MA 02215, USA. Electronic address: dwk@bu.edu.
authors: D W
authors: DW
authors: Kaufman
authors: Bayer HealthCare Pharmaceuticals, Montville, NJ, USA.
authors: S
authors: S
authors: Reshef
authors: Care-Safe LLC, Waltham, MA, USA; Harvard-M.I.T. Division of Health, Sciences and Technology, Cambridge, MA, USA.
authors: H L
authors: HL
authors: Golub
authors: Care-Safe LLC, Waltham, MA, USA.
authors: M
authors: M
authors: Peucker
authors: Slone Epidemiology Center at Boston University, 1010 Commonwealth Avenue, Boston, MA 02215, USA; Care-Safe LLC, Waltham, MA, USA.
authors: M J
authors: MJ
authors: Corwin
authors: Department of Neurology, University of California, San Francisco, CA, USA.
authors: D S
authors: DS
authors: Goodin
authors: Bayer HealthCare Pharmaceuticals, Montville, NJ, USA; Department of Neurology, Heinrich Heine University, Düsseldorf, Germany; Teva Pharmaceuticals, R&D CNS, Frazer, PA, USA.
authors: V
authors: V
authors: Knappertz
authors: Bayer HealthCare Pharmaceuticals, Montville, NJ, USA.
authors: D
authors: D
authors: Pleimes
authors: University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
authors: G
authors: G
authors: Cutter
keywords: Cohort studies; Epidemiology; Multiple sclerosis; Natural history studies; Survival