Excess mortality among patients with multiple sclerosis in Denmark has dropped significantly over the past six decades: a population based study
Excess mortality among patients with multiple sclerosis in Denmark has dropped significantly over the past six decades: a population based study
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DOI：
10.1136/jnnp-2017-315907
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发表时间：
2017-08-01
影响因子：
11
通讯作者：
Magyari, Melinda
中科院分区：
文献类型：
--
作者：
Koch-Henriksen, Nils;Laursen, Bjarne;Magyari, Melinda
背景多发性硬化症(MS)患者的预期寿命减少。很少有研究有足够的随访或足够的患者数量来评估生存率是否随着时间的推移而提高。然而，最近的一项荟萃分析发现，在最近十年的研究中，多发性硬化症的超额死亡率并没有随时间发生变化。目的调查丹麦总人口中多发性硬化症患者的短期全原因超额死亡率在过去60年中是否发生了变化。患者和方法我们纳入了丹麦全国多发性硬化症登记处记录的所有确诊或可能患有多发性硬化症的患者，发病时间从1950年到1999年。丹麦民事登记系统提供了2015年所有死亡患者的死亡日期，丹麦统计局提供了具体的人口死亡率。计算每1000人年超额死亡人数(EDR)和标化死亡率(SMR)。结果纳入18847例患者，其中死亡6102例，高于预期死亡2492例。EDR为10.63(95%CI为10.19~11.09)，SMR为2.45(95%CI为2.39~2.51)。15年EDR从1950~1959年发病队列的11.29(95%CI 9.95~12.73)逐渐下降到1990~1999年发病队列的2.56(95%CI 1.98~3.18)，SMR从4.48(95%CI 4.06~4.92)下降到1.80(95%CI 1.62~1.99)。结论MS短期超额死亡率的下降始于MS疾病调整治疗出现、MRI普及之前、McDonald诊断标准引入之前的几十年。恶性病例较少的多发性硬化症队列的改变可能是一个重要的因素。
Background Lifetime expectancy in multiple sclerosis (MS) is reduced. Few studies have had sufficient follow-up or sufficient number of patients to assess if survival has improved with time. However, a recent meta-analysis found no time-dependent change in MS excess mortality across studies over recent decades.Objective To investigate whether short-term all-cause excess mortality in patients with MS in the total Danish population has changed over the last six decades.Patients and methods We included all patients with MS recorded in the nationwide Danish MS Registry with definite or probable MS and onset from 1950 through 1999. The Danish Civil Registration System provided date of death for all deceased patients with follow-up in 2015, and Statistics Denmark supplied specific population mortality. We calculated excess number of death per 1000 person-years (EDR) and standardised mortality ratio (SMR).Results We included 18 847 patients among whom 6102 had died as opposed to 2492 expected deaths. EDR was 10.63 (95% CI 10.19 to 11.09) and a SMR was 2.45 (95% CI 2.39 to 2.51). The 15-year EDR dropped gradually from 11.29 (95% CI 9.95 to 12.73) in the 1950-1959 onset cohort to 2.56 (95% CI 1.98 to 3.18) in the 1990-1999 onset cohort, and SMR dropped from 4.48 (95% CI 4.06 to 4.92) to 1.80 (95% CI 1.62 to 1.99).Conclusion The decline in short-term excess mortality in MS started decades before disease-modifying treatment of MS became available, before use of MRI became widespread, and before the McDonald diagnostic criteria were introduced. A change in the MS cohorts with fewer malignant cases may be a significant contributor.