Myasthenia gravis is an autoimmune disease that causes easy fatigue and weakness of respiratory muscles. Due to the prolonged survival of patients, the prevalence of patients has now increased to 17.5 per 100,000. Analysis of the causes of death in MG patients can provide insight into whether the causes of death in MG patients differ compared to controls, whether there are specific diseases associated with MG that cause death, and whether these associated causes of death have changed with improved outcomes. The Norwegian Resident Cause of Death Registry records information on all deaths in Norway, and the study analyzed the causes of death of 249 people with MG between 1951 and 2001 (13 of whom had a combined thymoma) and compared them with 1245 other deaths in age-sex-matched populations living in the same area. The results showed that 28.1% of MG patients died from respiratory disease, compared with 20.9% of controls, and that the high incidence of respiratory disease was the most important cause of death among MG patients compared with controls, with this difference being particularly pronounced in men aged 30-69 years and women aged 50-69 years. In turn, the proportion of patients who died from respiratory disease before 1996 was significantly higher than the proportion of patients after 1996. The main respiratory illnesses causing death in MG patients were infectious diseases, including pneumonia (21.7%), chronic obstructive pulmonary disease (4.4%), and influenza (1.2%). Although 28.9% of MG patients died of heart disease, the percentage of MG patients who died of heart disease was significantly lower than that of controls (43.4%), and this difference was most pronounced in patients aged 50-59 years, with the percentage of male patients in this age group dying of heart disease being 19.4% in the MG group and 52% in the control group, and 14.6% in the MG group and 29.6% in the control group, respectively. 11.2% of MG patients died from malignant neoplasms compared to 27.2% of controls, and the percentage of MG patients of both sexes who died from neoplasms was significantly lower than that of controls (men: 11.1% of MG group, 22.2% of controls; women: 7.4% of MG group, 30.6% of controls). The investigators concluded that MG patients were more likely to die from respiratory disease compared to controls, which may be related to MG directly damaging the patients’ respiratory muscles. Dysphagia and respiratory failure were common symptoms of MG, and some patients even had respiratory failure as the first symptom. The maximum ventilation of patients with mild to moderate MG is namely 65%-75% of normal, suggesting that most patients with MG already have mild respiratory impairment although they have no respiratory symptoms or a clinical diagnosis of respiratory insufficiency. Dysphagia and respiratory muscle weakness make patients susceptible to infections, which further induce exacerbation of muscle weakness, so this combination of respiratory muscle weakness and infection may be an important factor leading to exacerbation or even death in MG patients. Immunotherapy and respiratory support are particularly important for patients who develop myasthenia gravis, and the development of intensive care has reduced myasthenia gravis mortality from 75% to less than 5%. the difference in the percentage of deaths from respiratory disease before and after 1996 suggests that patients have benefited from the availability of MG treatments. In addition, the investigators concluded that heart disease in MG patients is primarily related to the patient’s combination of thymoma, which can infiltrate the heart directly or cause arrhythmias in patients through paraneoplastic myocarditis. However, the rate of death from heart disease is much lower in MG patients than in controls, which may be related to the reduced life expectancy of patients.