Social consequences of multiple sclerosis. Part 2. Divorce and separation: a historical prospective cohort study.

BACKGROUND: There is a need for follow-up studies of the familial situation of multiple sclerosis (MS) patients. OBJECTIVES: To evaluate the probability of MS patients to remain in marriage or relationship with the same partner after onset of MS in comparison with the population. PATIENTS AND METHODS: All 2538 Danes with onset of MS 1980-1989, retrieved from the Danish MS-Registry, and 50,760 matched and randomly drawn control persons were included. Information on family status was retrieved from Statistics Denmark. Cox analyses were used with onset as starting point. RESULTS: Five years after onset, the cumulative probability of remaining in the same relationship was 86% in patients vs. 89% in controls. The probabilities continued to deviate, and at 24 years, the probability was 33% in patients vs. 53% in the control persons (p < 0.001). Among patients with young onset (< 36 years of age), those with no children had a higher risk of divorce than those having children less than 7 years (Hazard Ratio 1.51; p < 0.0001), and men had a higher risk of divorce than women (Hazard Ratio 1.33; p < 0.01). CONCLUSION: MS significantly affects the probability of remaining in the same relationship compared with the background population.

Social consequences of multiple sclerosis: clinical and demographic predictors - a historical prospective cohort study.

BACKGROUND: Time to disability pension is one of the endpoints to be used to determine the prognosis of multiple sclerosis (MS) in prospective studies. OBJECTIVE: To assess the time to cessation of work and receiving disability pension in MS, and how it may depend on gender, type of work and age and symptom at onset. METHOD: A total of 2240 Danes with onset of definite/probable MS 1980-1989, identified from the Danish MS-Registry, were included. Information on social endpoints was retrieved from Statistics Denmark. Cox regression analyses were used with onset as starting point. RESULTS: Afferent onset symptoms [hazard ratio (HR 0.57)] and non-physical type of work (HR 0.70) were favourable prognostic factors compared with high age at onset, physical work and efferent symptoms at onset. The mean time to disability pension was 13 years for patients with afferent/brainstem onset symptom but 8.7 years for those with efferent onset symptoms (P < 0.0001). The effect of onset symptom was reduced and the effect of sex became significant when all covariates and age at onset were included in multivariate Cox regression. CONCLUSIONS: Onset age, type of onset symptom and work are robust predictors of disability pension in MS. Disability pension proves to be a reliable milestone in estimation of the prognosis of MS.

Head injury is not a risk factor for multiple sclerosis: a prospective cohort study.

BACKGROUND: The idea of physical trauma being involved in the causation of multiple sclerosis (MS) had been discussed since the earliest description of the illness. Despite the ongoing debate, the proposed association between physical and especially head trauma and MS failed to be proved or to be refuted conclusively. OBJECTIVE: To determine whether head trauma is associated with an increased risk of developing MS. METHOD: A cohort of 150,868 subjects, 95,111 men, and 55,757 women registered in the National Danish Patient Registry with hospital admission for cerebral concussion, contusion, or skull fracture between 1977 and 1992, aged under 55, was selected. This trauma cohort was linked with the Danish MS Registry and followed up to the end of 1999 to retrieve subjects who had onset of MS after the year of the head trauma. We calculated the expected number of subjects, who, under a null-hypothesis, would subsequently develop MS, by using population age-, year-, and sex-specific MS-incidence densities from the Danish MS Registry. RESULTS: For men and women combined, the observed to expected number of MS cases (possible cases included) with onset after the head injury was 182/193.6 (standardized incidence ratio [SIR], 0.94; 95% CI, 0.81-1.09) and for possible MS excluded, 171/164.7 (SIR, 1.04; 95% CI, 0.89-1.21). In an analysis of a sub-cohort of 16,425 subjects with severe trauma (contusion, traumatic cerebral hemorrhage, and base or skull fracture), the observed to expected numbers, including possible MS, were 15/15.3 (SIR, 0.98; 95% CI, 0.55-1.62) and with possible MS excluded, 13/12.9 (SIR, 1.01; 95% CI, 0.53-1.73). As for the total group and for any of the subgroups and for men and women separately, none of the SIRs differed statistically significantly from unity. Neither were there any trends, which could be missed by type II errors. CONCLUSION: Head injury of any severity does not affect the risk of acquiring MS later in life.