Earlier deaths from MS reveal racial disparities

Clinical takeaway: Comprehensive MS care should extend beyond disease-modifying therapy. Routinely assess and treat cardiovascular risk factors, particularly hypertension, and consider barriers that may delay diagnosis or specialty care.

Multiple sclerosis (MS) shortens life expectancy by an estimated 7 to 14 years, and recent advances in disease-modifying therapies have raised hopes for improved survival. However, a large national study found that age-specific MS mortality increased across racial and ethnic groups during the study period, with Black patients dying at younger ages than White patients and hypertension emerging as an increasingly common contributor to MS-related deaths.

Researchers analyzed 42,205 US death certificates from 2012 through 2023 in which MS was listed as the underlying cause of death.

"We would expect that advances in treatments for MS might flatten these trends over time, but we continue to see increasing death rates," said study author Lilyana Amezcua, MD. "That tells us we still have work to do, particularly when it comes to managing other health conditions that affect people with MS."

The most striking disparity was by race. MS mortality peaked at ages 65 to 74 among Black patients but 75 to 84 among White patients. Black individuals also had the highest age-adjusted mortality rates overall, while Hispanic patients had substantially lower mortality rates.

Cardiovascular disease emerged as an increasingly important contributor to mortality. Hypertension was the most common comorbidity among MS-related deaths, and hypertension-related mortality increased from 2019 through 2023, particularly among Black and White patients. Deaths involving cardiac arrest also increased after 2019, with the greatest rise observed among Black patients.

Mortality patterns also varied geographically, with the highest MS mortality rates concentrated in northern and Midwestern states. Because the study relied on death certificates, it could not assess disease severity, disease-modifying therapy use, socioeconomic factors, or health care access, all of which may contribute to the observed disparities.

"Many of these conditions are preventable or treatable," Dr. Amezcua said. "Instead of focusing solely on MS, it's important to provide comprehensive care that takes a person's overall health into account."

Source: Amezcua L, et al. (2026 Jul 22) Neurology. Multiple sclerosis mortality in the United States: Trends, disparities, and co-occurring conditions