Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality
To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS. We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of dia...
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| Published in: | Neurology Vol. 89; no. 16; p. 1668 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
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17.10.2017
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| ISSN: | 1526-632X, 1526-632X |
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| Abstract | To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS.
We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of diagnosis, we compared individuals with and without chronic comorbidity using multinomial logistic regression. To investigate mortality, we used Cox regression with time-dependent covariates, following study participants from clinical MS onset until endpoint (death) or to the end of the study, censuring at emigration.
We identified 8,947 individuals with clinical onset of MS between 1980 and 2005. In the study of time of diagnosis, we found statistically significant odds ratios for longer diagnostic delays with cerebrovascular comorbidity (2.01 [1.44-2.80]; <0.0005), cardiovascular comorbidity (4.04 [2.78-5.87]; <0.0005), lung comorbidity (1.93 [1.42-2.62]; <0.0005), diabetes comorbidity (1.78 [1.04-3.06]; 0.035), and cancer comorbidity (2.10 [1.20-3.67]; 0.009). In the mortality study, we found higher hazard ratios with psychiatric comorbidity (2.42 [1.67-3.01]; <0.0005), cerebrovascular comorbidity (2.47 [2.05-2.79]; <0.0005), cardiovascular comorbidity (1.68 [1.39-2.03]; <0.0005), lung comorbidity (1.23 [1.01-1.50]; 0.036), diabetes comorbidity (1.39 [1.05-1.85]; 0.021), cancer comorbidity (3.51 [2.94-4.19]; <0.0005), and Parkinson disease comorbidity (2.85 [1.34-6.06]; 0.007).
An increased awareness of both the necessity of neurologic evaluation of new neurologic symptoms in persons with preexisting chronic disease and of optimum treatment of comorbidity in MS is critical. |
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| AbstractList | To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS.
We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of diagnosis, we compared individuals with and without chronic comorbidity using multinomial logistic regression. To investigate mortality, we used Cox regression with time-dependent covariates, following study participants from clinical MS onset until endpoint (death) or to the end of the study, censuring at emigration.
We identified 8,947 individuals with clinical onset of MS between 1980 and 2005. In the study of time of diagnosis, we found statistically significant odds ratios for longer diagnostic delays with cerebrovascular comorbidity (2.01 [1.44-2.80]; <0.0005), cardiovascular comorbidity (4.04 [2.78-5.87]; <0.0005), lung comorbidity (1.93 [1.42-2.62]; <0.0005), diabetes comorbidity (1.78 [1.04-3.06]; 0.035), and cancer comorbidity (2.10 [1.20-3.67]; 0.009). In the mortality study, we found higher hazard ratios with psychiatric comorbidity (2.42 [1.67-3.01]; <0.0005), cerebrovascular comorbidity (2.47 [2.05-2.79]; <0.0005), cardiovascular comorbidity (1.68 [1.39-2.03]; <0.0005), lung comorbidity (1.23 [1.01-1.50]; 0.036), diabetes comorbidity (1.39 [1.05-1.85]; 0.021), cancer comorbidity (3.51 [2.94-4.19]; <0.0005), and Parkinson disease comorbidity (2.85 [1.34-6.06]; 0.007).
An increased awareness of both the necessity of neurologic evaluation of new neurologic symptoms in persons with preexisting chronic disease and of optimum treatment of comorbidity in MS is critical. To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS.OBJECTIVETo investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS.We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of diagnosis, we compared individuals with and without chronic comorbidity using multinomial logistic regression. To investigate mortality, we used Cox regression with time-dependent covariates, following study participants from clinical MS onset until endpoint (death) or to the end of the study, censuring at emigration.METHODSWe conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of diagnosis, we compared individuals with and without chronic comorbidity using multinomial logistic regression. To investigate mortality, we used Cox regression with time-dependent covariates, following study participants from clinical MS onset until endpoint (death) or to the end of the study, censuring at emigration.We identified 8,947 individuals with clinical onset of MS between 1980 and 2005. In the study of time of diagnosis, we found statistically significant odds ratios for longer diagnostic delays with cerebrovascular comorbidity (2.01 [1.44-2.80]; <0.0005), cardiovascular comorbidity (4.04 [2.78-5.87]; <0.0005), lung comorbidity (1.93 [1.42-2.62]; <0.0005), diabetes comorbidity (1.78 [1.04-3.06]; 0.035), and cancer comorbidity (2.10 [1.20-3.67]; 0.009). In the mortality study, we found higher hazard ratios with psychiatric comorbidity (2.42 [1.67-3.01]; <0.0005), cerebrovascular comorbidity (2.47 [2.05-2.79]; <0.0005), cardiovascular comorbidity (1.68 [1.39-2.03]; <0.0005), lung comorbidity (1.23 [1.01-1.50]; 0.036), diabetes comorbidity (1.39 [1.05-1.85]; 0.021), cancer comorbidity (3.51 [2.94-4.19]; <0.0005), and Parkinson disease comorbidity (2.85 [1.34-6.06]; 0.007).RESULTSWe identified 8,947 individuals with clinical onset of MS between 1980 and 2005. In the study of time of diagnosis, we found statistically significant odds ratios for longer diagnostic delays with cerebrovascular comorbidity (2.01 [1.44-2.80]; <0.0005), cardiovascular comorbidity (4.04 [2.78-5.87]; <0.0005), lung comorbidity (1.93 [1.42-2.62]; <0.0005), diabetes comorbidity (1.78 [1.04-3.06]; 0.035), and cancer comorbidity (2.10 [1.20-3.67]; 0.009). In the mortality study, we found higher hazard ratios with psychiatric comorbidity (2.42 [1.67-3.01]; <0.0005), cerebrovascular comorbidity (2.47 [2.05-2.79]; <0.0005), cardiovascular comorbidity (1.68 [1.39-2.03]; <0.0005), lung comorbidity (1.23 [1.01-1.50]; 0.036), diabetes comorbidity (1.39 [1.05-1.85]; 0.021), cancer comorbidity (3.51 [2.94-4.19]; <0.0005), and Parkinson disease comorbidity (2.85 [1.34-6.06]; 0.007).An increased awareness of both the necessity of neurologic evaluation of new neurologic symptoms in persons with preexisting chronic disease and of optimum treatment of comorbidity in MS is critical.CONCLUSIONSAn increased awareness of both the necessity of neurologic evaluation of new neurologic symptoms in persons with preexisting chronic disease and of optimum treatment of comorbidity in MS is critical. |
| Author | Laursen, Bjarne Magyari, Melinda Koch-Henriksen, Nils Thormann, Anja Sørensen, Per Soelberg |
| Author_xml | – sequence: 1 givenname: Anja surname: Thormann fullname: Thormann, Anja email: anja.thormann.01@regionh.dk organization: From the Danish Multiple Sclerosis Center (A.T., P.S.S., M.M.), Department of Neurology, University of Copenhagen, Rigshospitalet; The Danish Multiple Sclerosis Registry (A.T., N.K.-H., M.M.), Department of Neurology, Rigshospitalet, Copenhagen; Department of Clinical Epidemiology (N.K.-H.), Clinical Institute, University of Aarhus; and The Danish National Institute of Public Health (B.L.), University of Southern Denmark, Copenhagen. anja.thormann.01@regionh.dk – sequence: 2 givenname: Per Soelberg surname: Sørensen fullname: Sørensen, Per Soelberg organization: From the Danish Multiple Sclerosis Center (A.T., P.S.S., M.M.), Department of Neurology, University of Copenhagen, Rigshospitalet; The Danish Multiple Sclerosis Registry (A.T., N.K.-H., M.M.), Department of Neurology, Rigshospitalet, Copenhagen; Department of Clinical Epidemiology (N.K.-H.), Clinical Institute, University of Aarhus; and The Danish National Institute of Public Health (B.L.), University of Southern Denmark, Copenhagen – sequence: 3 givenname: Nils surname: Koch-Henriksen fullname: Koch-Henriksen, Nils organization: From the Danish Multiple Sclerosis Center (A.T., P.S.S., M.M.), Department of Neurology, University of Copenhagen, Rigshospitalet; The Danish Multiple Sclerosis Registry (A.T., N.K.-H., M.M.), Department of Neurology, Rigshospitalet, Copenhagen; Department of Clinical Epidemiology (N.K.-H.), Clinical Institute, University of Aarhus; and The Danish National Institute of Public Health (B.L.), University of Southern Denmark, Copenhagen – sequence: 4 givenname: Bjarne surname: Laursen fullname: Laursen, Bjarne organization: From the Danish Multiple Sclerosis Center (A.T., P.S.S., M.M.), Department of Neurology, University of Copenhagen, Rigshospitalet; The Danish Multiple Sclerosis Registry (A.T., N.K.-H., M.M.), Department of Neurology, Rigshospitalet, Copenhagen; Department of Clinical Epidemiology (N.K.-H.), Clinical Institute, University of Aarhus; and The Danish National Institute of Public Health (B.L.), University of Southern Denmark, Copenhagen – sequence: 5 givenname: Melinda surname: Magyari fullname: Magyari, Melinda organization: From the Danish Multiple Sclerosis Center (A.T., P.S.S., M.M.), Department of Neurology, University of Copenhagen, Rigshospitalet; The Danish Multiple Sclerosis Registry (A.T., N.K.-H., M.M.), Department of Neurology, Rigshospitalet, Copenhagen; Department of Clinical Epidemiology (N.K.-H.), Clinical Institute, University of Aarhus; and The Danish National Institute of Public Health (B.L.), University of Southern Denmark, Copenhagen |
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| Snippet | To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS.
We conducted a population-based,... To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS.OBJECTIVETo investigate the effect... |
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| SubjectTerms | Adult Autoimmune Diseases - epidemiology Cardiovascular Diseases - epidemiology Cerebrovascular Disorders - epidemiology Cohort Studies Community Health Planning Comorbidity Delayed Diagnosis - mortality Denmark - epidemiology Female Humans Kidney Diseases - epidemiology Logistic Models Male Middle Aged Mood Disorders - epidemiology Multiple Sclerosis - diagnosis Multiple Sclerosis - epidemiology Multiple Sclerosis - mortality Neoplasms - epidemiology Neurologic Examination Parkinson Disease - epidemiology Time Factors Young Adult |
| Title | Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality |
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