Salter Amber, Tyry Tuula, Wang Guoqiao, Fox Robert J, Cutter Gary, Marrie Ruth Ann
Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada.
Neurol Clin Pract. 2016 Oct;6(5):397-408. doi: 10.1212/CPJ.0000000000000269.
In multiple sclerosis (MS), comorbidities have been associated with disability progression and an increased risk of mortality. We investigated the association between comorbidities and mortality in MS after accounting for disability and health behaviors.
We followed North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants who completed the Fall 2006 survey on comorbidities until death (reported or matched in the National Death Index) or date of last follow-up in 2014. We used proportional hazards regression to investigate the association between comorbidities and mortality, controlling for demographic, clinical, health behavior, and disability factors.
Of 9,496 participants meeting the inclusion criteria, 502 (5.3%) were deceased. Most participants reported having ≤3 comorbid conditions (70.9% survivors, 76.9% decedents). In individual regression models, vascular, visual, and mental comorbidities were associated with increased mortality risk after adjustment for factors associated with survival. When combined into a single model, vascular (hazard ratio 1.269; 1.041-1.547), visual (1.490; 1.199-1.852), and mental comorbidities (excluding anxiety, 1.239; 1.024-1.499) remained independently associated with an increased risk of mortality.
Presence of comorbidities was independently associated with an increased risk of mortality as compared to absence of comorbidities after adjusting for factors associated with survival. Specifically, vascular, visual, and mental comorbidities increased the risk of mortality. This highlights the need for clinicians to attend to these comorbidities, which can be modified by treatments or other interventions, and potentially reduce the risk of mortality in persons with MS who have these conditions.
在多发性硬化症（MS）中，合并症与残疾进展及死亡风险增加有关。我们在考虑了残疾和健康行为因素后，研究了MS合并症与死亡率之间的关联。
我们对北美多发性硬化症研究委员会（NARCOMS）登记处中完成2006年秋季合并症调查的参与者进行随访，直至其死亡（在国家死亡指数中报告或匹配）或2014年最后随访日期。我们使用比例风险回归来研究合并症与死亡率之间的关联，并控制人口统计学、临床、健康行为和残疾因素。
在9496名符合纳入标准的参与者中，502人（5.3%）死亡。大多数参与者报告有≤3种合并症（70.9%的幸存者，76.9%的死者）。在个体回归模型中，在调整了与生存相关的因素后，血管、视觉和精神合并症与死亡风险增加相关。当合并到一个单一模型中时，血管合并症（风险比1.269；置信区间1.041 - 1.547）、视觉合并症（1.490；置信区间1.199 - 1.852）和精神合并症（不包括焦虑症，1.239；置信区间1.024 - 1.499）仍然与死亡风险增加独立相关。
在调整了与生存相关的因素后，与无合并症相比，合并症的存在与死亡风险增加独立相关。具体而言，血管、视觉和精神合并症增加了死亡风险。这凸显了临床医生关注这些合并症的必要性，这些合并症可通过治疗或其他干预措施得到改善，并有可能降低患有这些疾病的MS患者的死亡风险。
