Background Approximately a quarter of a million people in the UK are living with long-term neurological conditions (LTNCs) including multiple sclerosis (MS), motor neuron disease (MND) and idiopathic Parkinson’s disease (IPD). Previous studies have investigated survival rates, mortality trends and causes of deaths in LTNCs individually. However, there is little evidence comparing causes of death across different LTNCs. We aim to investigate associations between cause-specific mortality and LTNC-associated mortality.
Methods We used individual death registration data for those aged >25 in England (2012–2014), provided by Office for National Statistics (ONS). Deaths from external causes were excluded. A condition listed as either the underlying or a contributory cause of death was defined as a mentioned cause. We calculated the frequency of mentioned causes in LTNC and non-LTNC deaths. Using STATA 13.1, logistic regression was used to estimate univariate associations between LTNCs and mentioned causes of death (crude odds ratios (OR), 95% confidence intervals (CI)). P-values were derived using likelihood ratio tests.
Results A total of 1,303,138 deaths were analysed. There were 4,652 (0.4%) MS-associated deaths; 6,197 (0.5%) MND-associated deaths; 25,238 (1.9%) IPD-associated deaths; 274 (0.02%) multiple system atrophy (MSA)-associated deaths; and 486 (0.04%) progressive supranuclear palsy (PSP)-associated deaths. The odds of pneumonitis due to food and vomit were higher in individuals with LTNCs compared to those without. The OR for pneumonitis was 5.84 for MS (95% CI: 5.38–6.35), 4.00 for MND (95% CI: 3.69–4.35) and 4.45 for IPD/MSA/PSP (95% CI: 4.27–4.64). MS-associated deaths had increased odds for pressure sores (OR 11.21, 95% CI: 7.08–17.74), urinary tract infections (UTI) (OR 3.32, 95% CI: 3.00–3.68), sepsis (OR 1.96, 95% CI: 1.76–2.17) and pneumonia (OR 1.93, 95% CI: 1.81–2.05) compared to non-MS deaths. Individuals with IPD, MSA and PSP had higher odds of dementia (OR 1.99, 95% CI: 1.94–2.05), UTI (OR 1.66, 95% CI: 1.56–1.76), pneumonia (OR 1.49, 95% CI: 1.45–1.53), fractures (OR 1.21, 95% CI: 1.07–1.38) and senility (OR 1.19, 95% CI: 1.15–1.24) as a mentioned cause of death compared to people without.
Conclusion People who die from LTNCs are more likely to suffer from pneumonitis, pneumonia and UTI, among others. These findings provide insight into the multiple factors affecting individuals with LTNCs and their associated mortality. Our conclusions are limited by the nature of ONS data and rely on accurate recording. A greater awareness of the mentioned causes of death in patients with LTNCs can help shape policy and provide benchmarks for clinical practice.
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