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Alotaibi, Zhu, Duggan, Tremlett, and Kingwell: When the death certificate says multiple sclerosis – exploring contributing causes of death

Introduction: Life expectancy is reduced in people with multiple sclerosis (MS) by approximately 6–10 years. MS is often not the actual cause of death. There is limited information on what causes contribute to a MS-related death.

Objectives: To investigate the role of MS as a reported cause of death using multiple cause-of-death data from British Columbia (BC), Canada, and to identify causes of death associated with MS when it is recorded on the death certificate.

Materials and methods: This was a population-based study using the Vital Statistics Agency death records from the province of BC, Canada, of all adult deaths (> 18 years old) between 1986 and 2009. Mentioned causes of death (underlying or contributing) were grouped using the International Classification of Disease codes. Associations between MS as a mentioned cause and other specific mentioned causes were assessed by sex-specific odds ratios (OR) stratified by age and year at death.

Results: A total of 643 125 deaths were reported during this time period. MS was mentioned in 1795 deaths (0.28%). Pulmonary-related infections or inflammation were highly associated with MS deaths. For example, the odds of pneumonitis being mentioned in association with MS was 7.16 times higher in women and 7.64 higher in men than for deaths with no mention of MS. Sex differences were evident; among all deaths, MS was mentioned more frequently for women (0.38%) than for men (0.19%). Urinary tract infections (UTIs) had a relatively stronger association with MS deaths in men (OR 14.74) than in women (OR 9.12), although UTIs were highly associated with MS deaths in both sexes, as were kidney infections and septicaemia.

Conclusions: Pulmonary-related causes of deaths and infections (pulmonary infections, septicaemia, UTIs and kidney infections) were most highly associated with MS deaths. Multiple cause of death data are highly complex and further analysis is required.

Acknowledgements: The BC Vital Statistics Agency approved access to and use of data facilitated by Population Data BC. Mohammed Alotaibi was funded by a MITACS Globalink Research Internship Award.

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