| 1. |
- Brenner, P., et al.
(författare)
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Multiple sclerosis and risk of attempted and completed suicide : a cohort study
- 2016
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Ingår i: European Journal of Neurology. - Hoboken, USA : Wiley-Blackwell Publishing Inc.. - 1351-5101 .- 1468-1331. ; 23:8, s. 1329-1336
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Patients with multiple sclerosis (MS) are known to have an elevated suicide risk, but attempted suicide is incompletely investigated. The relation between education level and suicidality has not been investigated in MS patients. Our objective was to estimate attempted suicide and completed suicide risks amongst MS patients.Methods: A total of 29 617 Swedish MS patients were identified through the Swedish Patient Register and matched with 296 164 people without MS from the general population. Cox regression analysis estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for the association of MS with attempted and completed suicide, with adjustment for age, sex, education and calendar period.Results: The adjusted HR for attempted suicide amongst MS patients is 2.18 (95% CI 1.97-2.43) compared with the general population cohort. For completed suicide the HR is 1.87 (95% CI 1.53-2.30). In both groups women are at higher risk of attempting suicide, whilst men are at higher risk of completing suicide. Education level is inversely associated with completed suicide amongst the non-MS cohort (0.68, 0.51-0.91), but not amongst MS patients (1.10, 0.60-2.04).Conclusion: Multiple sclerosis patients are at higher risk of both attempted and completed suicide. No evidence was found of an inverse association between educational level and risk of completed suicide amongst MS patients.
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| 3. |
- Montgomery, Scott, et al.
(författare)
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Hospital admission due to infections in multiple sclerosis patients
- 2013
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Ingår i: European Journal of Neurology. - : Blackwell Publishing. - 1351-5101 .- 1468-1331. ; 20:8, s. 1153-1160
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Multiple sclerosis (MS) patients are at increased infection risk. Here the influences of susceptibility, severity and surveillance bias on infection-related hospital admission are assessed.Methods: Swedish registers identified 20 276 patients with MS, matched with 203 951 people from the general population without MS. Risk of first hospital admission for infection and mortality over 36 years was estimated by Poisson regression.Results: Multiple sclerosis was associated with an increased hospital admission risk for all infections, with an adjusted relative risk (and 95% confidence interval) of 4.26 (4.13-4.40). A proportion of this raised risk was probably due to surveillance and referral bias, although a raised risk remained when MS was compared with other immune-mediated diseases. The 1-month mortality rate following hospital admission for infection was higher in MS patients than in the comparison cohort, with a relative risk of 4.69 (4.21-5.22). There was no clear temporal trend in the results, and risks were higher in males and varied by MS phenotype.Conclusions: Higher hospital admission rates among MS patients for infection are likely to be due to a combination of surveillance bias, cautious medical management and greater susceptibility to severe infections. MS-related functional limitations may increase infection risk and this should be considered in MS management.
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| 4. |
- Roshanisefat, H., et al.
(författare)
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All-cause mortality following a cancer diagnosis amongst multiple sclerosis patients : a Swedish population-based cohort study
- 2015
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Ingår i: European Journal of Neurology. - : Blackwell Publishing. - 1351-5101 .- 1468-1331. ; 22:7, s. 1074-1080
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: A reduced cancer risk amongst patients with multiple sclerosis (MS) has been reported. Theoretically, this could represent a genuine reduction in risk or, alternatively, diagnostic neglect', where cancer is undiagnosed when symptoms are misattributed to MS.Objective: Assess all-cause mortality risk following a cancer diagnosis in patients with MS compared with a cohort without MS.Patients: A cohort of MS patients (n=19364) and a cohort of the general population (n=192519) were extracted from national Swedish registers from 1969 to 2005. All-cause mortality after cancer in MS was compared with the general population. Poisson regression analysis was conducted in the MS and non-MS cohorts separately. The models were adjusted for follow-up duration, year at entry, sex, region and socioeconomic index. The two cohorts were combined and differences in mortality risk were assessed using interaction testing.Results: The adjusted relative risk (and 95% confidence interval) for all-cause mortality following a cancer diagnosis in MS patients (compared with MS patients without cancer) is 3.06 (2.86-3.27; n=1768) and amongst those without MS 5.73 (5.62-5.85; n=24965). This lower magnitude mortality risk in the MS patients was confirmed by multiplicative interaction testing (P<0.001).Conclusions: A consistent pattern of lower magnitude of all-cause mortality risk following cancer in MS patients for a range of organ-specific cancer types was found. It suggests that cancer diagnoses tend not to be delayed in MS and diagnostic neglect is unlikely to account for the reduced cancer risk associated with MS. The lower magnitude cancer risk in MS may be due to disease-associated characteristics or exposures.
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| 5. |
- Roshanisefat, H., et al.
(författare)
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Appendicectomy and multiple sclerosis risk
- 2011
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 18:4, s. 667-669
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Tidskriftsartikel (refereegranskat)abstract
- Background: Appendicectomy for acute appendicitis, but not for other causes, is inversely associated with immune-mediated diseases such as ulcerative colitis, suggesting appendicitis is a marker of immune characteristics influencing immune-mediated disease risk. This study investigated the association of appendectomy and its underlying diagnosis with multiple sclerosis (MS). Methods: Swedish general population registers and the Swedish MS register provided information on 20 542 cases with MS diagnosed between 1964-2006 and 204 157 controls matched for age, sex, period and region. Appendicectomy prior to MS diagnosis was identified in 673 cases and 6518 controls. Conditional logistic regression, with adjustment for socio-economic index, assessed the association of diagnosis underlying appendicitis with MS risk. Results: A perforated appendix, the best indicator of acute appendicitis in this material, was inversely associated with MS, although not statistically significantly, with an odds ratio (and 95% confidence interval of 0.86 (0.70-1.04). The odds ratios are 1.04 (0.94-1.16) for appendicitis without perforation and 1.14 (0.98-1.33) for appendectomy without appendicitis. Conclusion: Although inconclusive in terms of assessing the hypothesis, these results may help to explain why earlier studies of appendicitis and MS risk have been inconsistent, as there may be variation in association by diagnosis underlying appendicectomy.
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| 6. |
- Roshanisefat, H., et al.
(författare)
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Multiple sclerosis clinical course and cardiovascular disease risk : Swedish cohort study
- 2014
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Ingår i: European Journal of Neurology. - : Wiley-Blackwell. - 1351-5101 .- 1468-1331. ; 21:11, s. 1353-e88
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Cardiovascular disease (CVD) risk amongst multiple sclerosis (MS) patients appears raised, but few studies have examined CVD risk amongst an unselected MS patient group. MS course may be relevant for CVD risk. Our aim was to assess CVD risk and variation by course in MS patients.Methods: The Multiple Sclerosis Register identified 7667 patients who received an MS diagnosis between 1964 and 2005. They were matched by age, period, region and sex with 76045 members of the general population without MS using Swedish registers. Poisson regression compared the two cohorts to estimate the relative risk for CVD, overall, as well as grouped and individual CVD diagnoses.Results: MS patients had an increased adjusted relative risk (with 95% confidence intervals; number of MS cohort events) for CVD of 1.31 (1.22-1.41; n=847), with some variation by course: relapsing-remitting 1.38 (1.17-1.62; n=168); secondary progressive 1.30 (1.18-1.53; n=405) and primary progressive 1.15 (0.93-1.41; n=108). The association for the relapsing-remitting course was not significant after excluding the first year of follow-up. Overall incidence rates per 1000 person-years for CVD are 11.8 (11.06-12.66) for the MS cohort and 8.8 (8.60-9.05) for the non-MS cohort. The most pronounced association was for deep vein thrombosis: relapsing-remitting 2.16 (1.21-3.87; n=14), secondary progressive 3.41 (2.45-4.75; n=52) and primary progressive 3.57 (1.95-6.56; n=15). MS was associated with ischaemic stroke but largely during the first year of follow-up. MS was associated with a decreased relative risk for angina pectoris and atrial fibrillation.Conclusions: There is a significantly increased relative risk for CVD in MS, particularly for venous thromboembolic disorders in progressive MS, suggesting immobility as a possible factor. An increased frequency of ischaemic stroke in MS is most probably due to surveillance bias resulting from diagnostic investigations for MS. There is no increased relative risk for ischaemic heart disease in MS and atrial fibrillation appears to be less common than amongst the general population. Click for the corresponding questions to this CME article.
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| 10. |
- Crielaard, L, et al.
(författare)
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Factors associated with and long-term outcome of benign multiple sclerosis: a nationwide cohort study
- 2019
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Ingår i: Journal of neurology, neurosurgery, and psychiatry. - : BMJ. - 1468-330X .- 0022-3050. ; 90:7, s. 761-767
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Tidskriftsartikel (refereegranskat)abstract
- Benign multiple sclerosis (BMS) is often defined by the Expanded Disability Status Scale (EDSS) score of ≤3.0 after ≥15 years of disease duration. This classification’s clinical relevance remains unclear as benign patients may suffer other impairments and advance towards a progressive course, prompting our objective to holistically investigate factors associated with BMS and its long-term prognosis.MethodsBenign cases were identified in the Swedish Multiple Sclerosis registry. Baseline clinical data, demographic features and influence of multiple sclerosis (MS) major risk alleles on likelihood of benign course were investigated. Physical disability (EDSS), cognitive function (Symbol Digit Modalities Test; SDMT) and self-reported and socioeconomic differences between benign and non-benign patients were evaluated using generalised estimation equations models.Results11222 patients (2420 benign/8802 non-benign) were included. Benign patients were more likely to be female and younger at MS onset, have fewer relapses within the first two and 5 years from onset and fully recover from the first relapse (p<0.001). No association between human leucocyte antigen (HLA) DRB1*15:01 carriership (OR: 0.97, 95% CI: 0.86 to 1.09) or HLA-A*02:01 lacking (OR: 0.99, 95% CI: 0.87 to 1.11) and benign/non-benign was found. Non-benign patients accumulated an extra 0.04 (95% CI 0.03 to 0.04, p<0.001) EDSS score/year, lost an extra 0.3 (95% CI − 0.39 to − 0.18, p<0.001) SDMT score/year and deteriorated faster in self-reported impact and socioeconomic measures (p<0.001).ConclusionPatients with BMS have a better disease course as they progress more slowly at the group level in all respects. Lack of an association with major genetic risk factors indicates that MS course is most likely influenced by either environmental factor(s) or genetic factors outside the HLA region.
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