Effects of Age and Disease Duration on Excess Mortality in Patients With Multiple Sclerosis From a French Nationwide Cohort
| Autor: | Laurent Remontet, Fabien Rollot, Emmanuelle Leray, Zoé Uhry, Mathieu Fauvernier, Nadine Bossard, Ofsep Investigators, Sandra Vukusic |
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| Přispěvatelé: | Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hospices Civils de Lyon (HCL), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département Méthodes quantitatives en santé publique (METIS), Collectif de recherche handicap, autonomie et société inclusive (CoRHASI), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en neurosciences de Lyon (CRNL) |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Multiple Sclerosis Effects of age Sclérose en plaques (SEP) Disease duration [SDV]Life Sciences [q-bio] Effest de l'âge 01 natural sciences Cohort Studies 010104 statistics & probability 03 medical and health sciences 0302 clinical medicine medicine Humans In patient Mortality 0101 mathematics Aged Excess death Aged 80 and over Excess mortality business.industry Multiple sclerosis Mortality rate Surmortalité Hazard ratio Age Factors Middle Aged medicine.disease Multiple sclerosis (MS) Confidence interval 3. Good health Cohort Disease Progression Female France Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Neurology Neurology, 2021, 97 (4), pp.e403-e413. ⟨10.1212/WNL.0000000000012224⟩ Neurology, American Academy of Neurology, 2021, 97 (4), pp.e403-e413. ⟨10.1212/WNL.0000000000012224⟩ |
| ISSN: | 0028-3878 1526-632X |
| DOI: | 10.1212/WNL.0000000000012224⟩ |
| Popis: | ObjectiveTo determine the effects of current age and disease duration on excess mortality in multiple sclerosis (MS), we describe the dynamics of excess death rates over these 2 time scales and study the effect of age at MS clinical onset on these dynamics, separately in each initial phenotype.MethodsWe used data from 18 French MS expert centers participating in the Observatoire Français de la Sclérose en Plaques. Patients with MS living in metropolitan France and having a clinical onset between 1960 and 2014 were included. Vital status was updated on January 1, 2016. For each MS phenotype separately (relapsing onset [RMS] or primary progressive [PPMS]), we used an innovative statistical method to model the logarithm of excess death rates by a multidimensional penalized spline of age and disease duration.ResultsAmong 37,524 patients (71% women, mean age at MS onset ± SD 33.0 ± 10.6 years), 2,883 (7.7%) deaths were observed and 7.8% of patients were lost to follow-up. For patients with RMS, there was no excess mortality during the first 10 years after disease onset; afterwards, whatever the age at onset, excess death rates increased with current age. From current age 70, the excess death rate values converged and became identical whatever the age at disease onset, which means that disease duration had no more effect. Excess death rates were higher in men, with an excess hazard ratio of 1.46 (95% confidence interval 1.25–1.70). In contrast, in patients with PPMS, excess death rates rapidly increased from disease onset, and were associated with age at onset, but not with sex.ConclusionsIn RMS, current age has a stronger effect on MS mortality than disease duration, while their respective effects are not clear in PPMS. |
| Databáze: | OpenAIRE |
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