Comparison of Two Methods for Estimating MS-Related Mortality: The Excess Mortality vs. the Cause-Specific Frameworks
- Type de publi. : Article dans une revue
- Date de publi. : 12/12/2023
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Auteurs :
Fabien RollotZoe UhryEmmanuelle DantonySandra VukusicMarc DebouverieEmmanuelle Le PageJonathan CironAurélie RuetJérôme de SèzeHélène ZéphirPierre M LabaugeGilles DeferChristine Lebrun-FrénayThibault MoreauDavid-Axel LaplaudEric BergerPierre ClavelouJean PelletierEric ThouvenotOlivier HeinzlefJean-Philippe CamdessanchéFauvernier, M.Laurent RemontetEmmanuelle Leray
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Organismes :
Hospices Civils de Lyon
Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
Fondation Eugène Devic EDMUS
Santé publique France - French National Public Health Agency [Saint-Maurice, France]
Hospices Civils de Lyon
Laboratoire de Biométrie et Biologie Evolutive - UMR 5558
Hospices Civils de Lyon
Hospices Civils de Lyon
Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
Fondation Eugène Devic EDMUS
Adaptation, mesure et évaluation en santé. Approches interdisciplinaires
Service de neurologie [CHRU Nancy]
Service de Neurologie [CHU Rennes]
Centre d'Investigation Clinique [Rennes]
Institut Toulousain des Maladies Infectieuses et Inflammatoires
Département Neurologie [CHU Toulouse]
Neurocentre Magendie : Physiopathologie de la Plasticité Neuronale
Service de neurologie [Bordeaux]
CIC Strasbourg
Lille Neurosciences & Cognition - U 1172
CHU Montpellier = Montpellier University Hospital
Service de Neurologie [CHU Caen]
Service de Neurologie [CHU Nice]
CHU Dijon
Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
Service de Neurologie [CHRU Besançon]
Neuro-Dol
Service Neurologie [CHU Clermont-Ferrand]
Hôpital de la Timone [CHU - APHM]
Institut de Génomique Fonctionnelle
Service de Neurologie [CHU Nimes]
Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
Service de Neurologie [CHU de Saint-Étienne]
Laboratoire de Biométrie et Biologie Evolutive - UMR 5558
Hospices Civils de Lyon
Service de Biostatistiques [Lyon]
Laboratoire de Biométrie et Biologie Evolutive - UMR 5558
Hospices Civils de Lyon
Centre d'Investigation Clinique [Rennes]
Recherche en Pharmaco-épidémiologie et Recours aux Soins
Département Méthodes quantitatives en santé publique
École des Hautes Études en Santé Publique
Université de Rennes
Arènes: politique, santé publique, environnement, médias
Collectif de recherche handicap, autonomie et société inclusive
Recherche sur les services et le management en santé
- Publié dans Neurology le 01/11/2020
Résumé : Background and objectives - Determining whether multiple sclerosis (MS) causes death is challenging. Our objective was to contrast 2 frameworks to estimate probabilities of death attributed to MS (P) and other causes (P): the cause-specific framework (CSF), which requires the causes of death, and the excess mortality framework (EMF), which does not. Methods - We used data from the Observatoire Français de la Sclérose en Plaques (OFSEP, n = 37,524) and from a comparative subset where causes of death were available (4,004 women with relapsing-onset MS [R-MS]). In CSF, the probabilities were estimated using the Aalen-Johansen method. In EMF, they were estimated from the excess mortality hazard, which is the additional mortality among patients with MS as compared with the expected mortality in the matched general population. P values were estimated at 30 years of follow-up, (1) with both frameworks in the comparative subset, by age group at onset, and (2) with EMF only in the OFSEP population, by initial phenotype, sex, and age at onset. Results - In the comparative subset, the estimated 30-year P values were greater using EMF than CSF: 10.9% (95% CI 8.3-13.6) vs 8.7% (6.4-11.8) among the youngest and 20.4% (11.3-29.5) vs 16.2% (8.7-30.2) for the oldest groups, respectively. In the CSF, probabilities of death from unknown causes ranged from 1.5% (0.7-3.0) to 6.4% (2.5-16.4), and even after their reallocation, P values remained lower with CSF than with EMF. The estimated probabilities of being alive were close using the 2 frameworks, and the estimated P (EMF vs CSF) was 2.6% (2.5-2.6) vs 2.1% (1.2-3.9) and 18.1% (16.9-19.3) vs 26.4% (16.5-42.2), respectively, for the youngest and oldest groups. In the OFSEP population, the estimated 30-year P values ranged from 7.5% (6.4-8.7) to 24.0% (19.1-28.9) in patients with R-MS and from 25.4% (21.1-29.7) to 36.8% (28.3-45.3) in primary progressive patients, depending on sex and age. Discussion - EMF has the great advantage of not requiring death certificates, their quality being less than optimal. Conceptually, it also seems more relevant because it avoids having to state, for each individual, whether death was directly or indirectly caused by MS or whether it would have occurred anyway, which is especially difficult in such chronic diseases.
Source