Tobacco smoking and excess mortality in multiple sclerosis: a cohort study

Ali Manouchehrinia, Mikail Weston, Christopher R Tench, John Britton, Cris S Constantinescu, Ali Manouchehrinia, Mikail Weston, Christopher R Tench, John Britton, Cris S Constantinescu

Abstract

Objective: As patients with multiple sclerosis (MS) have more than 2.5-fold increased mortality risk, we sought to investigate the impact of tobacco smoking on the risk of premature death and its contribution to the excess mortality in MS patients.

Methods: We studied 1032 patients during the period 1994-2013 in a UK-based register. Cox regression model was used to investigate the impact of smoking on the risk of premature death, controlling for confounders. Smoking-specific mortality rates were compared with the UK general population.

Results: Of 923 patients with clinically definite MS, 80 (46 males and 34 females) had died by December 2012. HRs for death in current smokers and ex-smokers relative to never smokers were 2.70 (95% CI 1.59 to 4.58, p<0.001) and 1.30 (95% CI 0.72 to 2.32; p = 0.37). The standardised mortality ratio, compared with the UK general population, when stratified by smoking status was 3.83 (95% CI 2.71 to 5.42) in current smokers, 1.96 (95% CI 1.27 to 3.0) in ex-smokers and 1.27 (95% CI 0.87 to 1.86) in non-smokers. Never smokers and ex-smokers with MS had similar mortality rates compared with never smokers and ex-smokers without MS in the male British doctors cohort (1.12 (95% CI 0.63 to 1.97) and 0.54 (95% CI 0.26 to 1.14), respectively), while current smokers with MS had 84% higher rate of death compared with current smokers without MS (95% CI 1.24 to 2.72).

Conclusions: Tobacco smoking can account for some of the excess mortality associated with MS and is a risk determinant for all-cause and MS-related death.

Keywords: MULTIPLE SCLEROSIS.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Cox proportional hazard regression graph showing survival from birth (A) by lifelong smoking status and (B) latest smoking status.

References

    1. Bronnum-Hansen H, Koch-Henriksen N, Stenager E. Trends in survival and cause of death in Danish patients with multiple sclerosis. Brain 2004;127(Pt 4):844–50
    1. Sadovnick AD, Ebers GC, Wilson RW, et al. Life expectancy in patients attending multiple sclerosis clinics. Neurology 1992;42:991–4
    1. Kingwell E, van der Kop M, Zhao Y, et al. Relative mortality and survival in multiple sclerosis: findings from British Columbia, Canada. J Neurol Neurosurg Psychiatry 2012;83:61–6
    1. Scalfari A, Knappertz V, Cutter G, et al. Mortality in patients with multiple sclerosis. Neurology 2013;81:184–92
    1. WHO. WHO report on the global tobacco epidemic: warning about the dangers of tobacco. 2011
    1. Sakata R, McGale P, Grant EJ, et al. Impact of smoking on mortality and life expectancy in Japanese smokers: a prospective cohort study. BMJ 2012;345:e7093.
    1. Huxley RR, Woodward M. Full hazards of smoking and benefits of stopping for women. Lancet 2013;381:96–8
    1. Hernan MA, Jick SS, Logroscino G, et al. Cigarette smoking and the progression of multiple sclerosis. Brain 2005;128(Pt 6):1461–5
    1. Sundstrom P, Nystrom L. Smoking worsens the prognosis in multiple sclerosis. Mult Scler 2008;14:1031–5
    1. Healy BC, Ali EN, Guttmann CR, et al. Smoking and disease progression in multiple sclerosis. Arch Neurol 2009;66:858–64
    1. Manouchehrinia A, Tench CR, Maxted J, et al. Tobacco smoking and disability progression in multiple sclerosis: United Kingdom cohort study. Brain 2013;136(Pt 7):2298–304
    1. Elbaz A, Bower JH, Peterson BJ, et al. Survival study of Parkinson disease in Olmsted County, Minnesota. Arch Neurol 2003;60:91–6
    1. Nortvedt MW, Riise T, Maeland JG. Multiple sclerosis and lifestyle factors: the Hordaland Health Study. Neurol Sci 2005;26:334–9
    1. Poser CM, Paty DW, Scheinberg L, et al. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983;13:227–31
    1. McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001;50:121–7
    1. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444–52
    1. Roxburgh RH, Seaman SR, Masterman T, et al. Multiple Sclerosis Severity Score: using disability and disease duration to rate disease severity. Neurology 2005;64:1144–51
    1. Hirst C, Swingler R, Compston DA, et al. Survival and cause of death in multiple sclerosis: a prospective population-based study. J Neurol Neurosurg Psychiatry 2008;79:1016–21
    1. Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004;328:1519.
    1. Office for National Statistics. 2012. .
    1. StataCorp. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP, 2009
    1. Peto R, Darby S, Deo H, et al. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ 2000;321:323–9
    1. Mackenzie IS, Morant SV, Bloomfield GA, et al. Incidence and prevalence of multiple sclerosis in the UK 1990–2010: a descriptive study in the General Practice Research Database. J Neurol Neurosurg Psychiatry 2014;85:76–84
    1. Sumelahti ML, Tienari PJ, Wikstrom J, et al. Survival of multiple sclerosis in Finland between 1964 and 1993. Mult Scler 2002;8:350–5
    1. Smestad C, Sandvik L, Celius EG. Excess mortality and cause of death in a cohort of Norwegian multiple sclerosis patients. Mult Scler 2009;15:1263–70
    1. Leray E, Morrissey SP, Yaouanq J, et al. Long-term survival of patients with multiple sclerosis in West France. Mult Scler 2007;13:865–74
    1. Goodin DS, Reder AT, Ebers GC, et al. Survival in MS: a randomized cohort study 21 years after the start of the pivotal IFNbeta-1b trial. Neurology 2012;78:1315–22
    1. Tsai CP, Lee CT. Impact of disease-modifying therapies on the survival of patients with multiple sclerosis in Taiwan, 1997–2008. Clin Drug Investig 2013;33:647–52
    1. Rothman KJ, Greenland S, Lash TL. Modern epidemiology. 3rd edn Philadelphia, PA: London: Lippincott Williams & Wilkins, 2008
    1. Lalmohamed A, Bazelier MT, Van Staa TP, et al. Causes of death in patients with multiple sclerosis and matched referent subjects: a population-based cohort study. Eur J Neurol 2012;19:1007–14
    1. Becklake MR, Lalloo U. The ‘healthy smoker’: a phenomenon of health selection? Respiration 1990;57:137–44
    1. Pope CA, III, Burnett RT, Turner MC, et al. Lung cancer and cardiovascular disease mortality associated with ambient air pollution and cigarette smoke: shape of the exposure-response relationships. Environ Health Perspect 2011;119:1616–21
    1. Marrie RA, Rudick R, Horwitz R, et al. Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis. Neurology 2010;74:1041–7
    1. Lange P, Vestbo J, Nyboe J. Risk factors for death and hospitalization from pneumonia. A prospective study of a general population. Eur Respir J 1995;8:1694–8
    1. LaCroix AZ, Lipson S, Miles TP, et al. Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors, and nutritional status. Public Health Rep 1989;104:350–60

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