title: Mortality and comorbidities in patients with multiple sclerosis compared with a population without multiple sclerosis: An observational study using the US Department of Defense administrative claims database.
abstract: BACKGROUND
  Data are limited for mortality and comorbidities in patients with multiple sclerosis (MS).
  
  
  OBJECTIVE
  Compare mortality rates and event rates for comorbidities in MS (n=15,684) and non-MS (n=78,420) cohorts from the US Department of Defense (DoD) database.
  
  
  METHODS
  Comorbidities and all-cause mortality were assessed using the database. Causes of death (CoDs) were assessed through linkage with the National Death Index. Cohorts were compared using mortality (MRR) and event (ERR) rate ratios.
  
  
  RESULTS
  All-cause mortality was 2.9-fold higher in the MS versus non-MS cohort (MRR, 95% confidence interval [CI]: 2.9, 2.7-3.2). Frequent CoDs in the MS versus non-MS cohort were infectious diseases (6.2, 4.2-9.4), diseases of the nervous (5.8, 3.7-9.0), respiratory (5.0, 3.9-6.4) and circulatory (2.1, 1.7-2.7) systems and suicide (2.6, 1.3-5.2). Comorbidities including sepsis (ERR, 95% CI: 5.7, 5.1-6.3), ischemic stroke (3.8, 3.5-4.2), attempted suicide (2.4, 1.3-4.5) and ulcerative colitis (2.0, 1.7-2.3), were higher in the MS versus non-MS cohort. The rate of cancers was also higher in the MS versus the non-MS cohort, including lymphoproliferative disorders (2.2, 1.9-2.6) and melanoma (1.7, 1.4-2.0).
  
  
  CONCLUSIONS
  Rates of mortality and several comorbidities are higher in the MS versus non-MS cohort. Early recognition and management of comorbidities may reduce premature mortality and improve quality of life in patients with MS.
authors.affiliation: Novartis Pharma AG, Basel, Switzerland. Electronic address: gorana.capkun-niggli@novartis.com.
authors.forename: Gorana
authors.initials: G
authors.lastname: Capkun
authors.affiliation: Novartis Pharma AG, Basel, Switzerland. Electronic address: frank.dahlke@novartis.com.
authors.forename: Frank
authors.initials: F
authors.lastname: Dahlke
authors.affiliation: Novartis Pharma AG, Basel, Switzerland. Electronic address: raquel.lahoz@novartis.com.
authors.forename: Raquel
authors.initials: R
authors.lastname: Lahoz
authors.affiliation: Evidera, Lexington, MA, USA. Electronic address: Beth.Nordstrom@evidera.com.
authors.forename: Beth
authors.initials: B
authors.lastname: Nordstrom
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. Electronic address: htilson@email.unc.edu.
authors.forename: Hugh H
authors.initials: HH
authors.lastname: Tilson
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: cutterg@uab.edu.
authors.forename: Gary
authors.initials: G
authors.lastname: Cutter
authors.affiliation: Novartis Pharma AG, Basel, Switzerland. Electronic address: dorina.bischof@novartis.com.
authors.forename: Dorina
authors.initials: D
authors.lastname: Bischof
authors.affiliation: Novartis Pharma AG, Basel, Switzerland. Electronic address: alan.moore@novartis.com.
authors.forename: Alan
authors.initials: A
authors.lastname: Moore
authors.affiliation: Evidera, Lexington, MA, USA. Electronic address: Jason.Simeone@evidera.com.
authors.forename: Jason
authors.initials: J
authors.lastname: Simeone
authors.affiliation: Evidera, Lexington, MA, USA. Electronic address: Kathy.Fraeman@evidera.com.
authors.forename: Kathy
authors.initials: K
authors.lastname: Fraeman
authors.affiliation: Novartis Pharma AG, Basel, Switzerland. Electronic address: fabrice.bancken@novartis.com.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bancken
authors.affiliation: Novartis Pharma AG, Basel, Switzerland. Electronic address: yvonne.geissbuehler@novartis.com.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Geissbühler
authors.affiliation: Department of Neurology, Naval Medical Center Portsmouth, Portsmouth, VA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Providence Brain and Spine Institute, St Vincent Medical Center, Portland, OR, USA. Electronic address: Stanley.Cohan@providence.org.
authors.forename: Stanley
authors.initials: S
authors.lastname: Cohan
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D059030:United States Department of Defense / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Administrative claims; Causes of death; Comorbidities; Multiple sclerosis