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“Of MS and Men” Morbidity & Mortality Outcomes. Mitchell T. Wallin, MD, MPH MS Clinic Director Department of Veterans Affairs Medical Center Washington, DC Assistant Professor of Neurology Georgetown University Medical School. “Of MS and Men” Morbidity & Mortality Outcomes. I. Definitions

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of ms and men morbidity mortality outcomes
“Of MS and Men”Morbidity & Mortality Outcomes

Mitchell T. Wallin, MD, MPH

MS Clinic Director

Department of Veterans Affairs Medical Center

Washington, DC

Assistant Professor of Neurology

Georgetown University Medical School

of ms and men morbidity mortality outcomes2
“Of MS and Men”Morbidity & Mortality Outcomes

I. Definitions

II. Morbidity Data

III. Mortality & Survival Data

IV. Conclusions

secondary progressive ms vs primary progressive ms

RR-SP MS

PP MS

Age at onset (mean)

30 yrs

40 yrs

Sex ratio (M:F)

2:1

1:1

Race

disability progression in AA

disability progression in AA

Onset symptoms

Sensory, visual

Paraparesis

Secondary Progressive MSvs. Primary Progressive MS
of ms and men morbidity mortality outcomes5
“Of MS and Men”Morbidity & Mortality Outcomes

I. Definitions

II. Morbidity Data

III. Mortality & Survival Data

IV. Conclusions

2

prevalence of subtypes of ms
Prevalence of Subtypes of MS

Progressive-

relapsing

(PR)

5%

(N = 3019)

Primary-

progressive

(PP)

10%

Relapsing-remitting

(RR)

55%

Secondary-progressive

(SP)

30%

Jacobs et al. Mult Scler. 1999;5:369-376.

ms morbidity in the us
MS Morbidity in the US
  • Nationwide Prevalence
    • 58/100,000 population (Baum, 1981)
    • 102-139/100,000 population (Anderson, 1992)
    • 85/100,000 population (Noonan, 2002)
  • Olmsted County, MN (Mayr 2003)
    • Raw Incidence: 7.5/100,000 person-yrs
    • Raw Prevalence: 177/100,000 person-yrs
vietnam and later military service ms cohort study population flow chart wallin et al 2004
Vietnam and later military service MS cohort Study Population Flow Chart (Wallin, et al 2004)

Eligible MS patients

55345

Eligible Controls

10683

394

1305

MS Cases

Analyzed

4951

Controls Analyzed

9378

adjusted case control ratios for ms by race and sex at ead

WWII-KC Cohort

Vietnam and later Cohort

Race-sex category

# of MS cases

Case-control ratio (95% CI)

# of MS cases

Case-control ratio (95% CI)

White female

182

1.86

(1.44 – 2.38)

604

2.85

(2.49-3.25)

Black female

4

1.33

(0.23 – 9.10)

123

2.74

(2.00-3.52)

Other

race-female

2

----

16

3.37

(1.52-7.56)

White male

4,923

1.04

(0.98 – 1.10)

3,758

0.96

(0.90-1.00)

Black male

177

0.45

(0.38 – 0.54)

415

0.64

(0.57-0.43)

Other

race-male

17

0.23

(0.14 – 0.39)

35

0.29

(0.20-0.41)

TOTAL

5,305

1.00

4,951

1.00

Adjusted case-control ratios for MS by race and sex at EAD
slide15

Vietnam & Later Service

129

111

116

169

143

116

160

152

55

180

141

138

230

113

216

141

108

126

86

101

147

103

107

110

115

73

67

67

144

83

80

79

94

83

81

74

56

81

92

59

81

63

62

54

54

62

46

75

Case Control Ratios x 100

< 60

61 to 90

91 to 120

121 to 149

>150

WWII-KC

167

200

131

183

161

211

131

198

172

127

117

145

118

118

203

133

118

105

92

116

85

138

78

121

101

132

74

95

131

72

109

86

64

61

66

44

59

61

67

61

52

64

56

41

48

52

61

50

Case Control Ratios x 100

< 60

61 to 90

91 to 120

121 to 149

>150

risk of bone loss in men weinstock guttman 2004
Risk of Bone Loss in MenWeinstock-Guttman, 2004

40 male MS patients, mean: EDSS 5.8; Age 51yrs

  • 32 (80%) with reduced bone loss of lumbar spine or femur
    • 17 (43%) had osteopenia
    • 15 (38%) had osteoporosis
  • 8/38 (21%) with fractures of ribs, vertebrae or extremities
  • Risk factors for low bone mineral density
    • Femoral neck: EDSS and BMI
    • Lumbar spine: EDSS
of ms and men morbidity mortality outcomes18
“Of MS and Men”Morbidity & Mortality Outcomes

I. Definitions

II. Morbidity Data

III. Mortality & Survival Data

IV. Conclusions

2

ms survival
MS Survival
  • 10 years shorter than age-matched general population (Brønnum-Hansen, 2004)
  • US Veteran WWII Cohort (Wallin, 2000)
    • Men: median survival
      • Black males: 30 yrs
      • White males: 34 yrs
    • White women: median survival 43 yrs
  • Secular trend for improved survival over the past 50 years
risk factors for ms survival

Study

Year of Study

Region

Total cases

Age at onset

Sex

Clin

course

Leibowitz

1967

Israel

266

+/-

+

Visscher

1980

USA

941

+

NS

Phadke

1980

UK

1055

+

NS

+

Riise

1986

Norway

598

+

NS

+

Poser

1981

Germany

224/1429

+

+

Wynn

1984

USA

206

+

+

Brønnum-Hansen

1986

Denmark

6727

+

+

Midgard

1991

Norway

251

+

NS

+

Wallin

1996

USA

2489

+

+

Risk Factors for MS Survival
ms cause specific mortality
MS Cause-specific mortality
  • MS as underlying or contributing cause of death in 47%-83% of cases (Sadovnick, 1991; Larsen, 1985)
  • Other causes (Brønnum-Hansen, 2004)
    • Cardiovascular disease: SMR 1.32 (1.22-1.43)
    • Cancer: SMR 0.85 (0.77-0.94)
    • Suicide/Accidents: 1.42 (1.22-1.64)
conclusions
Conclusions
  • Despite a lower prevalence of MS, men are more likely to present with the PP subtype and generally have increased morbidity and mortality compared to women
  • Implications for clinical studies
    • Differential pathology by sex
    • Endocrine effects
  • More large longitudinal studies needed to evaluate sex differences in MS

9