Estimating the excess mortality of patients with multiple sclerosis according to prevalence and incidence data from 70 million statutory health insured patients in Germany during 2009-2015

Multiple Sclerosis (MS) is a chronic, inflammatory neurological disease affecting the central nervous system, with symptoms varying by MS type. For the first time in Germany, we estimated the mortality rate ratio (MRR) of MS patients and developed a procedure to reduce bias from false positives and negatives, particularly in younger age groups, providing robust estimates for current and future datasets. Using data from the Central Institute for Statutory Health Insurance (Zi) covering ~70 million insured individuals from 2009–2015, we applied the illness-death model (IDM) and ensured reliability via Bayesian Markov Chain Monte Carlo (MCMC) methods. Mortality rates were highest in younger patients and declined with age. These estimates highlight the true impact of MS, inform excess mortality, and may support public health planning.