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Sunday

 

"smoking approximately doubled the risk of death: Excess Mortality in MS Largely From Smoking"


Much of the early mortality seen in multiple sclerosis patients is related to their smoking habits, a researcher said here. 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 overrepresented in MS patients relative to the general population.

Because smoking is itself associated with a substantial reduction in life expectancy, Manouchehrinia said, he and his colleagues sought to determine how much it may contribute to early mortality in MS patients.

They examined data on 895 MS patients registered at Nottingham University Hospital who had been followed for up to 40 years after diagnosis. Smoking status was recorded in the data. A total of 66 patients in this cohort had died as of December 2011.

Average age at death was 65, whereas the mean age of survivors as of December 2011 was 52. Decedents were also largely male (58%), whereas 72% of survivors were women.

Such disparities necessitated a multivariate analysis to assess the role of smoking in mortality. After adjusting for these factors, it remained the case that smoking approximately doubled the risk of death in the cohort, Manouchehrinia said.

A Kaplan-Meier curve showed that, with disease duration of 45 years, the survival rate among ever-smokers was 50% compared with about 75% in lifetime nonsmokers.

The researchers also calculated that, compared with life expectancy in the general population, a total of 1,779 years of life were lost prematurely in the cohort -- 62% of which were in ever-smokers.


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