Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Eur J Neurol. 2012 Jul;19(7):1007-14. doi: 10.1111/j.1468-1331.2012.03668.x. Epub 2012 Feb 21.
Multiple sclerosis (MS) has been associated with increased mortality rates. However, influence of lifestyle parameters remains unknown, and inconsistencies exist regarding findings for causes of death.
We conducted a population-based cohort study using the General Practice Research Database, Hospital Episode Statistics, and national death certificates (January 2001 through March 2008). To each patient with MS (n = 1270), up to six referent subjects without MS were matched by age, gender, and practice. Cox proportional hazards models were used to estimate mortality rate ratios (HRs).
Patients with MS had a 3.5-fold increased mortality rate for all-cause mortality, compared with referent subjects (HR 3.51, 95% CI 2.63-4.69). The rate further increased amongst current smokers (HR 6.72, 95% CI 4.16-10.87) (but not in ex-smokers) and subjects with a body mass index of <20 kg/m(2) (HR 6.67, 95% CI 3.50-12.73). The HR was highest for infectious/respiratory-related deaths (HR 7.69, 95% CI 4.92-12.02) and was significantly increased for deaths related to cardiovascular diseases (2.4-fold) and cancer (1.9-fold), but not for accidents and suicide related deaths.
British patients with MS have a 3.5-fold increased mortality rate compared with the general population. Smoking and respiratory diseases are major (potentially preventable) factors related to increased mortality rate amongst patients with MS.
多发性硬化症（MS）与死亡率的增加有关。然而，生活方式参数的影响尚不清楚，且关于死因的发现存在不一致。
我们使用一般实践研究数据库、医院事件统计数据和国家死亡证明（2001 年 1 月至 2008 年 3 月）进行了一项基于人群的队列研究。对每例多发性硬化症患者（n=1270），通过年龄、性别和实践与之匹配最多六位没有多发性硬化症的对照受试者。使用 Cox 比例风险模型估计死亡率比（HR）。
与对照受试者相比，多发性硬化症患者的全因死亡率增加了 3.5 倍（HR 3.51，95%CI 2.63-4.69）。在当前吸烟者（HR 6.72，95%CI 4.16-10.87）（而非前吸烟者）和 BMI<20 kg/m(2)的患者中，该比率进一步增加（HR 6.67，95%CI 3.50-12.73）。与传染性/呼吸道相关死亡的 HR 最高（HR 7.69，95%CI 4.92-12.02），且与心血管疾病（2.4 倍）和癌症（1.9 倍）相关的死亡显著增加，但与事故和自杀相关的死亡没有增加。
与普通人群相比，英国多发性硬化症患者的死亡率增加了 3.5 倍。吸烟和呼吸道疾病是多发性硬化症患者死亡率增加的主要（潜在可预防）因素。
