Epidemiology of multiple sclerosis in US veterans VIII. Long-term survivalafter onset of multiple sclerosis

Survival to 1996 was analysed for nearly 2500 veterans of World War II who were rated as 'service-connected' for multiple sclerosis as of 1956 by the then Veterans Administration. Survival from onset was defined for all white women and black men, and a random sample of white men. Median survival tim es from onset were 43 years (white females), 30 years (black males) and 34 years (white males), Crude 50-year survival rates were 31.5% (white females ), 21.5% (black males) and 16.6% (white males), but only the white females and white males were significantly different. A proportional hazard analysi s was used to identify risk factors for mortality from multiple sclerosis o nset gear. Significant risk factors included male sex (risk ratio: 1.57), o lder age at onset (risk ratio: 1.05 per year) and high socioeconomic status (risk ratio: 1.05 per socioeconomic status category), There were no statis tically significant differences in survival following multiple sclerosis on set by race or latitude of place of entry into military service, both signi ficant risk factors associated with the development of multiple sclerosis, Standardized mortality ratios utilizing national US data (for 1956-96) show ed a marked excess for all three race-sex groups of multiple sclerosis case s, with little difference among them, but with a decreasing excess over tim e. Relative survival rates, used to compare the survival of multiple sclero sis cases with that of other military veterans, did not differ significantl y by sex-race group, nor by latitude of place of entry into military servic e, but did differ significantly by socioeconomic class, The lack of differe nce in male and female relative survival rates suggests that the significan t difference in survival between male and female multiple sclerosis cases i s, at least in part, a result of sex per se and not the disease.