Can multiple sclerosis result in premature death?

While we often counsel patients that multiple sclerosis (MS) does not often result in death, we have noticed some MS patients with aggressive disease who clearly succumb prematurely. To understand survival in the MS population with a matched cohort from the general population, a population based study is needed to evaluate the association of comorbidity with survival in both populations. 

A recent study in Canada suggests a 7-year loss in those with MS. Using population-based administrative data, 5,797 persons with MS and 28,807 controls matched on sex, year of birth, and region were included in the study. The mean age at MS diagnosis was 41 years, and mean duration of follow-up was 13 years. Each MS case in the dataset was matched to five control cases. Researchers evaluated the association between comorbidity status and mortality, stratifying by birth cohort, and adjusting for sex, socioeconomic status, and region. Both primary and contributing causes of death were systematically evaluated. 

In the MS population, comorbidities included anxiety, depression, bipolar disorder, seizure disorder, fibromyalgia, and migraine, among others. The median survival was 76 years in the MS cohort and 83 years in the control cohort. The MS population had a 2.1-fold increased hazard of death. Death was attributable to MS and related complications in 44%, followed by disorders of the circulatory system, cancer, respiratory disease, and infection. Several comorbidities were associated with increased hazard of death in both populations, including diabetes, ischemic heart disease, depression, anxiety, and chronic lung disease.

This important study reveals that MS is associated with increased mortality. This mortality results from complications of MS and related immobility, along with other comorbidities. Prior studies suggested reduced mortality with use of disease-modifying therapies. This study did not include an evaluation of treatment effects in MS.

To improve overall wellbeing in MS, we should seek to preserve mobility and cognitive function through pharmacologic and non-pharmacologic means. People with MS should follow a healthy lifestyle, with a balanced diet and routine exercise, and should also seek routine care with primary care physicians for health screening and counseling.