Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios.
OBJECTIVE
There are inconsistent data on mortality in people with multiple sclerosis (MS). We performed a meta-analysis of all-cause, cause-specific and gender-specific crude mortality rates (CMRs), and standardised mortality ratios (SMRs) in MS, and estimated the rate of change of CMR and SMR over the past 50 years.


METHODS
Medline, Embase and the Cochrane Library were searched.


BACKGROUND
'Multiple Sclerosis' and ('standardised mortality' or 'standardized mortality').


METHODS
availability of data on the number of deaths; mean or median patient follow-up or reports of SMRs; being a longitudinal study. 12 studies were included covering the period 1949-2012 (27 423 patients; 6628 deaths; 437 832 person-years follow-up). CMR was calculated. SMRs were extracted. CMRs and natural logarithm of SMRs were pooled by the method of the inverse of the variance. Meta-regression models were used to investigate the secular trends.


RESULTS
Pooled CMR was 9.78/1000 person-years (95% CI 6.81 to 14.02). Pooled all-cause SMR was 2.80 (95% CI 2.74 to 2.87). All-cause SMR was 2.56 (95% CI 2.47 to 2.66) in males and 3.06 (95% CI 2.97 to 3.17) in females. SMR due to cancer was 0.89 (95% CI 0.83 to 0.97). SMRs due to cardiovascular diseases, suicide, infection and respiratory diseases were 1.29 (95% CI 1.20 to 1.38), 2.13 (95% CI 1.80 to 2.51) and 2.91 (95% CI 2.60 to 3.26). There was no trend in CMRs, all-cause, and gender-specific SMRs.


CONCLUSIONS
The excess mortality in MS relative to the general population has not changed over the past 50 years. Female patients with MS have higher survival disadvantage compared to that of males. Death due to cardiovascular diseases, suicide and infection is higher in patients with MS compared to the general population.
Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Ali
A
Manouchehrinia
Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK Department of Neurology, Neurosurgery and Psychiatry, University of Medicine and Pharmacy Carol Davila, Colentina Hospital, Bucharest, Romania.
Radu
R
Tanasescu
Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Christopher R
CR
Tench
Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Cris S
CS
Constantinescu
D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000401:mortality*; D012737:Sex Factors
EPIDEMIOLOGY; MULTIPLE SCLEROSIS