To examine 2 modifiable health behaviors—smoking and physical activity—and their relationship to mortality among individuals with multiple sclerosis (MS).
Secondary analysis of Large Health Survey.
Data were obtained from a linkage of the Veterans Affairs (VA) MS National Data Repository, containing information on service provision to all individuals with MS receiving health services within the U.S. Department of Veterans Affairs; the VA 1999 Large Health Survey, containing information on smoking and physical activity; and the VA Vital Status File. All-cause mortality was examined for the 15-year period from 1999 through 2013.
Participants (N=2994) with MS who completed the Large Health Survey containing information on smoking and physical activity.
Main Outcome Measure
There were 1500 deaths (50.1%) during the study period. Cox proportional hazard analyses were conducted to examine the association between smoking and physical activity and 15-year mortality. After adjusting for demographic factors, physical functioning, mental health, and comorbid medical conditions, baseline smoking was associated with greater mortality (hazard ratio [HR]=1.38; 95% confidence interval [CI], 1.184–1.60). Higher levels of baseline physical activity were associated with lower mortality (activity 1–2 times/wk: HR=.64; 95% CI, .518–.798; activity ≥3 times/wk: HR=.53; 95% CI, .388–.715).
Results suggest that modifiable health behaviors represent a promising opportunity for intervention to improve the lives of individuals with MS.
List of abbreviations:HR (hazard ratio), LVHS (Large Veteran Health Survey), MCS (Medical Component Summary), MS (multiple sclerosis), PCS (Physical Component Summary), SF-36v (Medical Outcomes Study 36-Item Short-Form Health Survey–Veterans version), SIC (Seattle Index of Comorbidity), VA (Veterans Affairs)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Epidemiology of multiple sclerosis.Neurol Clin. 1996; 14: 291-308
- Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors.Arch Phys Med Rehabil. 2009; 90: 646-651
- Multiple sclerosis.N Engl J Med. 2000; 343: 938-952
- Prevalence and correlates of depression among veterans with multiple sclerosis.Neurology. 2005; 64: 75-80
- Mortality in patients with multiple sclerosis.Neurology. 2013; 81: 184-192
- Trends in survival and cause of death in Danish patients with multiple sclerosis.Brain. 2004; 127: 844-850
- A 10-year follow-up of a population-based study of people with multiple sclerosis in Stockholm, Sweden: changes in disability and the value of different factors in predicting disability and mortality.J Neurol Sci. 2013; 332: 121-127
- Cardiorespiratory risk factors as predictors of 40-year mortality in women and men.Heart. 2009; 95: 1250-1257
- 21st-century hazards of smoking and benefits of cessation in the United States.N Engl J Med. 2013; 368: 341-350
- Global health risks: mortality and burden of disease attributable to selected major risks.World Health Organization, Geneva2009
- Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies.Int J Epidemiol. 2011; 40: 1382-1400
- Veterans Health Administration multiple sclerosis surveillance registry: the problem of case-finding from administrative databases.J Rehabil Res Dev. 2006; 43: 17-24
- Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life.Arch Phys Med Rehabil. 2009; 90: 420-428
- Smoking among veterans with multiple sclerosis: prevalence correlates, quit attempts, and unmet need for services.Arch Phys Med Rehabil. 2007; 88: 1394-1399
- Dissemination of methods and results from the Veterans Health Study: final comments and implications for future monitoring strategies within and outside the veterans healthcare system.J Ambul Care Manage. 2006; 29: 310-319
- Behavioral Risk Factors Surveillance System survey questionnaire.US Department of Health and Human Services, Atlanta1998
- A mail survey of physical activity habits as related to measured physical fitness.Am J Epidemiol. 1988; 127: 1228-1239
- Self-reported physical activity compared with maximal oxygen uptake.Am J Epidemiol. 1985; 122: 101-105
- The validity of self-reported exercise-induced sweating as a measure of physical activity.Am J Epidemiol. 1990; 132: 107-113
- Exercise and risk of stroke in male physicians.Stroke. 1999; 30: 1-6
- A prospective study of physical activity and risk of prostate cancer in US physicians.Int J Epidemiol. 2000; 29: 29-35
- A prospective study of exercise and incidence of diabetes among US male physicians.JAMA. 1992; 268: 63-67
- Health status and outcomes of veterans: physical and mental component summary scores, veterans SF-36, 1999 Large Health Survey of Veteran Enrollees.Office of Quality and Performance, Veterans Health Administration, Dept of Veterans Affairs, Washington (DC)2000
- Value of health-related quality of life to predict disability course in multiple sclerosis.Neurology. 2004; 63: 2046-2050
- Performance of the SF-36, SF-12, and RAND-36 summary scales in a multiple sclerosis population.Med Care. 2000; 38: 1022-1028
- Validation of case-mix measures derived from self-reports of diagnoses and health.J Clin Epidemiol. 2002; 55: 371-380
- Accuracy and completeness of mortality data in the Department of Veterans Affairs.Popul Health Metr. 2006; 4: 2
- Cigarette smoking and the progression of multiple sclerosis.Brain. 2005; 128: 1461-1465
- Smoking is associated with progressive disease course and increased progression in clinical disability in a prospective cohort of people with multiple sclerosis.J Neurol. 2009; 256: 577-585
- Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis.Mult Scler. 2002; 8: 161-168
- Impact of aerobic training on fitness and quality of life in multiple sclerosis.Ann Neurol. 1996; 39: 432-441
- Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance.Addiction. 2012; 107: 1066-1073
- Telephone-based physical activity counseling for major depression in people with multiple sclerosis.J Consult Clin Psychol. 2013; 81: 89-99
- The validity of self-reported smoking: a review and meta-analysis.Am J Public Health. 1994; 84: 1086-1093
- The validity of self-reported leisure time physical activity, and its relationship to serum cholesterol, blood pressure and body mass index. A population based study of 332,182 men and women aged 40-42 years.Eur J Epidemiol. 2003; 18: 479-485
Published online: November 06, 2014
Supported by a Veterans Affairs (VA) Rehabilitation Research and Development Service Career Development Award (grant no. B3319VA), the VA Center of Excellence in Substance Abuse Treatment and Education, the VA Multiple Sclerosis Center of Excellence West, VA Office of Quality and Performance, and National Multiple Sclerosis Society (grant no. MB0026).
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.