Excess Mortality in MS Largely From Smoking

LYON, France — Much of the early mortality seen in multiple sclerosis patients is related to their smoking habits, a researcher said here.

In a prospectively followed cohort of nearly 900 MS patients, 68% of those who died in a 40-year period were current or former smokers, compared with 50% of surviving patients, according to Ali Manouchehrinia of the University of Nottingham in England.

After adjusting for sex, age of MS onset, initial diagnosis (relapsing versus progressive MS), and use of disease-modifying drugs, the hazard ratio for death among ever-smokers versus lifetime nonsmokers was 2.13 (95% CI 1.26 to 3.61, P=0.005), he told attendees at the European Committee for Treatment and Research in Multiple Sclerosis annual meeting.

The mortality rate in ever-smokers was 5.48 per 1,000 person-years, compared with 2.30 per 1,000 person-years among the lifetime nonsmokers in the cohort.

Of the 66 patients in the cohort who died, 45 (68%) were smokers; 49% of the entire cohort were smokers.

Manouchehrinia noted that deaths among never-smokers in the cohort still tended to be premature relative to the general population. But the difference was less than half that seen among patients with a smoking history.

He also indicated that age of onset of significant disability was slightly younger in the ever- versus never-smokers, but the net result was that the never-smokers lived longer with disability, on average.

Overall life expectancy among MS patients is about 5 years less than in other people, for reasons that are unclear. Smoking, however, is a strong epidemiological risk factor for development of MS, which also means that smokers are over represented in MS patients relative to the general population.

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