Although treatment options for multiple sclerosis (MS) have improved, people with the condition still have a somewhat shorter average life expectancy. This is especially true for those who have other health conditions (known as comorbidities) as well as MS. Today, those with MS are more likely to die from complications of the disease than from MS itself.

Studies have analyzed the death certificates of thousands of people with MS in Canada and the U.S. to get a better understanding of the most common causes of death.

1. Vascular and Heart Disease

Vascular disease is one of the most commonly reported causes of death in people with MS. Vascular disease is a broad category of conditions that involve the blood vessels — arteries and veins. Vascular diseases may be genetic, caused by lifestyle choices like smoking or diet or both. Vascular disease can become deadly if blood clots cause strokes, heart attacks, or pulmonary embolism (when a clot makes its way to the lungs).

Vascular diseases, including cardiovascular disease (heart disease), are also the leading cause of death in the general population. However, studies show that people with MS have even higher relative mortality (death rates) associated with cardiovascular diseases than the general population.

Controlling conditions like diabetes, hypertension (high blood pressure), and high cholesterol levels can help prevent vascular diseases. If you have a vascular disease, it may be treated with medications, surgery, or lifestyle changes like getting more exercise or quitting smoking.

Research has found a connection between specific vascular diseases in women with MS who also have depression. A possible relationship among these three conditions might suggest a link between mental and physical health.

2. Cancer

Cancer is another leading cause of death for both the general population and for people with MS. Studies suggest lung cancer is one of the most deadly cancers for people with MS. Breast and colorectal cancer are also high on the list for the number of deaths they cause. Notably, the risk of dying from cancer among people with MS is not necessarily higher than that of the general population. Research on this topic has yielded mixed results. Some studies suggest a higher risk of certain cancers, such as bladder, prostate, and breast cancer, while others indicate a potential protective effect against some types of cancer for those with MS.

The relationship between MS and cancer is complicated. MS is often treated with medications that suppress part of the immune system to protect the nervous system. Although these treatments are critical for slowing down the MS disease course, they can also come with side effects. One potential side effect of dampening the immune system is lowering the body’s defenses against other threats, including cancer in some cases. However, some of the disease-modifying therapies (DMTs) for MS may actually help fight off cancer. Researchers still aren’t quite sure how all of these different factors may play into the development of cancer in people with MS.

Fortunately, you and your neurology team have a lot of different DMTs to choose from for treating MS. Your health care provider will look at your specific situation, including your individual and family medical history, to help weigh the risks and benefits of different drugs.

3. Respiratory Diseases

A chronic respiratory disease is any type of ongoing breathing or lung problem. Some studies report that people with MS have the greatest chance of dying from respiratory failure versus any other cause of death. Respiratory disease is also a common cause of death for people without MS, but it’s lower on the list in the general population. According to some studies, chronic respiratory disease kills men with MS more often than it kills women with MS, but the evidence is mixed. Also, respiratory diseases seem to start at younger ages when someone has MS.

MS-related breathing problems are common — more than 4,100 members of MyMSTeam report having breathing issues. Sometimes, they happen early in the disease or are caused by an infection. Other times, they’re the result of severe disability from MS that’s progressed to more advanced stages. In more advanced MS, the muscles needed for breathing can become weak. As a result, breathing gets tiring and harder to do. MS can also impact parts of the brain that control breathing, but this is rare.

People with MS are more likely to get certain types of chronic respiratory diseases than others. For example, chronic obstructive pulmonary disease (COPD) is more common in MS. But people with MS have the same risk for asthma as everyone else.

It’s crucial to get breathing problems diagnosed and treated as soon as symptoms begin. Doing targeted exercises to strengthen your chest muscles can help ward off some of the weakness that makes breathing harder over time. In addition, learning strategies to prevent chest infections (such as not talking while eating) can go a long way to preserving your breathing ability.

4. Infections

People with MS are more likely to die from infections compared to those without the disease. As noted above, respiratory infections are a serious concern. In the general population, respiratory infections are responsible for 12.7 percent of deaths, according to research cited in Neurology. However, in MS populations, this number goes up to 22.5 percent. Respiratory infections can happen if you swallow food the wrong way (aspiration pneumonia) or if you’re exposed to a virus or bacteria that makes you sick.

Urinary tract infections (UTIs) also pose a big danger to people with MS, regardless of their biological sex. People with MS tend to get UTIs more often due to the use of catheters and urinary retention or the inability to fully empty the bladder. Overall, women are more likely to get UTIs, according to Neurology, but in groups with MS, UTIs are actually more deadly to men than to women.

If a person with MS becomes immobile, they can develop pressure ulcers. These sores can quickly grow into widespread infections that enter the bloodstream and put life at risk. That being said, infections are treatable, especially if you catch them early.

Signs of an infection differ depending on the type of infection. In general, they can include:

• Fever and chills
• Muscle aches
• Diarrhea
• Feeling tired or fatigued
• Coughing

If you have a wound and notice that it’s not healing well, don’t wait to get medical treatment. People with MS must be vigilant about treating infections, especially if they are on therapies that suppress the immune system. Open communication with your health care team is essential for keeping you safe and avoiding unnecessary stressors.

How Can You Can Use This Information

Learning about different causes of death can be difficult. But remember, everyone is unique. While no one can escape death, you can lower your risk of certain chronic diseases by making good lifestyle choices. Above all, staying in touch with your health care team (in addition to your neurologist) can help you catch problems early and get treatment before smaller issues become life-threatening.

Managing MS may be your main health focus, but it’s not the only thing that deserves your attention. Scheduling recommended screenings, like blood work and colonoscopies, and attending any follow-ups may impact your mortality rate and help you extend your lifespan with MS.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 212,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Did receiving a diagnosis of MS make you more aware of your mortality risk? Do you have any comorbidities you’re concerned may lead to an increased risk of death? Share your thoughts in the comments below, or start a conversation by posting to your Activities feed.