Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex
Abstract Objective Elevated healthcare use before multiple sclerosis (MS) onset suggests earlier opportunity to identify MS. Yet their timing and sociodemographic effects are unclear. We examined rates of healthcare use (and by age/sex) for >two decades pre‐MS onset. Methods We identified people...
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Wiley
2025-02-01
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| Series: | Annals of Clinical and Translational Neurology |
| Online Access: | https://doi.org/10.1002/acn3.52267 |
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| author | Helen Tremlett Feng Zhu Karl Everett Ayesha Asaf Ali Manouchehrinia Ping Li Kyla A. McKay Jan Hillert Yinshan Zhao Colleen Maxwell Ruth Ann Marrie |
| author_facet | Helen Tremlett Feng Zhu Karl Everett Ayesha Asaf Ali Manouchehrinia Ping Li Kyla A. McKay Jan Hillert Yinshan Zhao Colleen Maxwell Ruth Ann Marrie |
| author_sort | Helen Tremlett |
| collection | DOAJ |
| description | Abstract Objective Elevated healthcare use before multiple sclerosis (MS) onset suggests earlier opportunity to identify MS. Yet their timing and sociodemographic effects are unclear. We examined rates of healthcare use (and by age/sex) for >two decades pre‐MS onset. Methods We identified people with MS (PwMS) using administrative data from Canada (Ontario) and Sweden (1991–2020) (“administrative” cohort), and the Swedish MS Registry (“clinical” cohort). The first MS/demyelinating diagnostic code (administrative) or symptom onset (clinical) defined MS onset. We compared annual rates of healthcare use (hospital, physician, and emergency‐room [ED]) pre‐onset between PwMS and up to five matched population controls using negative binomial regression, and by age/sex. Results The administrative cohort = 35,018/136,007 PwMS/controls (Ontario), and 10,269/51,297 (Sweden). Rates of healthcare use were higher for PwMS than controls up to 28 (of 29) years (Ontario) and up to 15 (of 19) years (Sweden) pre‐onset. Annual healthcare use rose steadily as onset approached, particularly escalating 7 years pre‐onset in Ontario (e.g., hospital visit rate ratios [RRs] exceeded 1.30), and 6 years in Sweden (physician visit RRs > 1.10). RRs peaked the year pre‐onset (ED visits [Ontario] = 3.04; 95% CI: 2.94–3.13, physician visits [Sweden] = 2.51; 95% CI: 2.44–2.59). In the year pre‐onset, RRs were disproportionately higher for males (ED RRs [Ontario] = 3.30; 95% CI: 3.13–3.48 vs. females = 2.90; 95% CI: 2.79–3.02), and dropped steadily by age (physician visit RRs [Sweden] = 2.61/2.27/1.97/1.72 for 50/40/30/20‐year‐olds). The smaller clinical cohort (7604/37,974 PwMS/controls) exhibited similar patterns, albeit more modest, with RRs elevated up to 5 years pre‐onset (physician visit RR [year‐5] = 1.08; 95% CI: 1.02–1.14; RR [year‐1] = 1.39;1.33–1.46). Interpretation Higher healthcare use was evident decades before MS onset, escalating 6–7 years pre‐onset, peaking the year before, being disproportionately higher for males and older PwMS. |
| format | Article |
| id | doaj-art-d6097608e4b84da1a96917c2dac66a85 |
| institution | OA Journals |
| issn | 2328-9503 |
| language | English |
| publishDate | 2025-02-01 |
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| series | Annals of Clinical and Translational Neurology |
| spelling | doaj-art-d6097608e4b84da1a96917c2dac66a852025-08-20T02:28:00ZengWileyAnnals of Clinical and Translational Neurology2328-95032025-02-0112241543210.1002/acn3.52267Healthcare use is elevated two decades before a first demyelinating event and differs by age and sexHelen Tremlett0Feng Zhu1Karl Everett2Ayesha Asaf3Ali Manouchehrinia4Ping Li5Kyla A. McKay6Jan Hillert7Yinshan Zhao8Colleen Maxwell9Ruth Ann Marrie10Faculty of Medicine (Neurology), and the Djavad Mowafaghian Centre for Brain Health University of British Columbia Vancouver British Columbia CanadaFaculty of Medicine (Neurology), and the Djavad Mowafaghian Centre for Brain Health University of British Columbia Vancouver British Columbia CanadaICES Toronto Ontario CanadaICES Toronto Ontario CanadaDepartment of Clinical Neuroscience, Karolinska Institutet, Department of Neurology Karolinska University Hospital Stockholm SwedenICES Toronto Ontario CanadaDepartment of Clinical Neuroscience, Karolinska Institutet, Department of Neurology Karolinska University Hospital Stockholm SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Department of Neurology Karolinska University Hospital Stockholm SwedenFaculty of Medicine (Neurology), and the Djavad Mowafaghian Centre for Brain Health University of British Columbia Vancouver British Columbia CanadaICES Toronto Ontario CanadaDepartment of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba CanadaAbstract Objective Elevated healthcare use before multiple sclerosis (MS) onset suggests earlier opportunity to identify MS. Yet their timing and sociodemographic effects are unclear. We examined rates of healthcare use (and by age/sex) for >two decades pre‐MS onset. Methods We identified people with MS (PwMS) using administrative data from Canada (Ontario) and Sweden (1991–2020) (“administrative” cohort), and the Swedish MS Registry (“clinical” cohort). The first MS/demyelinating diagnostic code (administrative) or symptom onset (clinical) defined MS onset. We compared annual rates of healthcare use (hospital, physician, and emergency‐room [ED]) pre‐onset between PwMS and up to five matched population controls using negative binomial regression, and by age/sex. Results The administrative cohort = 35,018/136,007 PwMS/controls (Ontario), and 10,269/51,297 (Sweden). Rates of healthcare use were higher for PwMS than controls up to 28 (of 29) years (Ontario) and up to 15 (of 19) years (Sweden) pre‐onset. Annual healthcare use rose steadily as onset approached, particularly escalating 7 years pre‐onset in Ontario (e.g., hospital visit rate ratios [RRs] exceeded 1.30), and 6 years in Sweden (physician visit RRs > 1.10). RRs peaked the year pre‐onset (ED visits [Ontario] = 3.04; 95% CI: 2.94–3.13, physician visits [Sweden] = 2.51; 95% CI: 2.44–2.59). In the year pre‐onset, RRs were disproportionately higher for males (ED RRs [Ontario] = 3.30; 95% CI: 3.13–3.48 vs. females = 2.90; 95% CI: 2.79–3.02), and dropped steadily by age (physician visit RRs [Sweden] = 2.61/2.27/1.97/1.72 for 50/40/30/20‐year‐olds). The smaller clinical cohort (7604/37,974 PwMS/controls) exhibited similar patterns, albeit more modest, with RRs elevated up to 5 years pre‐onset (physician visit RR [year‐5] = 1.08; 95% CI: 1.02–1.14; RR [year‐1] = 1.39;1.33–1.46). Interpretation Higher healthcare use was evident decades before MS onset, escalating 6–7 years pre‐onset, peaking the year before, being disproportionately higher for males and older PwMS.https://doi.org/10.1002/acn3.52267 |
| spellingShingle | Helen Tremlett Feng Zhu Karl Everett Ayesha Asaf Ali Manouchehrinia Ping Li Kyla A. McKay Jan Hillert Yinshan Zhao Colleen Maxwell Ruth Ann Marrie Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex Annals of Clinical and Translational Neurology |
| title | Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex |
| title_full | Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex |
| title_fullStr | Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex |
| title_full_unstemmed | Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex |
| title_short | Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex |
| title_sort | healthcare use is elevated two decades before a first demyelinating event and differs by age and sex |
| url | https://doi.org/10.1002/acn3.52267 |
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