@article{ref1,
title="Causes of death in patients with multiple sclerosis and matched referent subjects: a population-based cohort study",
journal="European journal of neurology",
year="2012",
author="Lalmohamed, A. and Bazelier, M. T. and Van Staa, T. P. and Uitdehaag, B. M. J. and Leufkens, H. G. M. and de Boer, A. and De Vries, F.",
volume="19",
number="7",
pages="1007-1014",
abstract="Background and purpose:  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. Methods:  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). Results:  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. Conclusion:  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.<p /> <p>Language: en</p>",
language="en",
issn="1351-5101",
doi="10.1111/j.1468-1331.2012.03668.x",
url="http://dx.doi.org/10.1111/j.1468-1331.2012.03668.x"
}