Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group

ABSTRACTA population-based cohort study was conducted in the Dutch PHARMO database to investigate prevalence and patterns of anti-infective medication use in children and adolescents with type 1 diabetes (T1D) before and after the onset of this disease. All patients <19 years with at least 2 insulin prescriptions (1999 to 2009) were identified (T1D cohort) and compared with an age- and sex-matched (ratio: 1 up to 4) diabetes-free reference group. The prevalence and average number of anti-infective use was studied from (up to) 8 years before until a maximum of 4 years after the onset of T1D. A total of 925 patients with T1D and 3,591 children and adolescents in the reference cohort (51% boys, mean age of 10.1 [standard deviation, 4.5] years) were included. The overall prevalence of anti-infective use (62.6 compared to 52.6%,P< 0.001) and average number of prescriptions (2.71 compared to 1.42 per child,P< 0.001) in the T1D cohort were significantly higher than those in the reference cohort after the onset of diabetes. This pattern was consistent across sex and age categories and already observed in the year before the onset of type 1 diabetes. Patients in the T1D cohort received more antibacterials (49.8 compared to 40%,P< 0.001), antimycotics (4.0 compared to 1.3%,P< 0.001), antivirals (2.5 compared to 0.4%,P< 0.001), and second-line antibiotics, such as aminoglycosides, quinolones, and third-generation cephalosporins and carbapenems. Our findings that elevated anti-infective use in the T1D cohort exists in the period before the onset of type 1 diabetes and the consumption of more second-line anti-infective compounds in this time period warrant further research.

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Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group

BMJ Open ◽

10.1136/bmjopen-2017-020392 ◽

2018 ◽

Vol 8 (5) ◽

pp. e020392 ◽

Cited By ~ 6

Author(s):

Chantelle Murley ◽

Olof Mogard ◽

Michael Wiberg ◽

Kristina Alexanderson ◽

Korinna Karampampa ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cohort Study ◽

Reference Group ◽

Population Based ◽

Disposable Income

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Earnings among people with multiple sclerosis compared to references, in total and by educational level and type of occupation: a population-based cohort study at different points in time

BMJ Open ◽

10.1136/bmjopen-2018-024836 ◽

2019 ◽

Vol 9 (7) ◽

pp. e024836 ◽

Cited By ~ 3

Author(s):

Michael Wiberg ◽

Chantelle Murley ◽

Petter Tinghög ◽

Kristina Alexanderson ◽

Edward Palmer ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cohort Study ◽

Educational Level ◽

Population Based ◽

Individual Characteristics ◽

University Education ◽

Educational Levels ◽

Before And After ◽

Working Age ◽

Large Heterogeneity

ObjectivesTo investigate earnings among people with multiple sclerosis (PwMS) before and after MS diagnosis compared with people without MS, and if identified differences were associated with educational levels and types of occupations. Furthermore, to assess the proportions on sickness absence (SA) and disability pension (DP) in both groups.DesignPopulation-based longitudinal cohort study, 10 years before until 5 years after MS diagnosis.SettingWorking-age population using microdata linked from nationwide Swedish registers.ParticipantsResidents in Sweden in 2004 aged 30–54 years with MS diagnosed in 2003–2006 (n=2553), and references without MS (n=7584) randomly selected by stratified matching.Outcome measuresQuartiles of earnings were calculated for each study year prior to and following the MS diagnosis. Mean earnings, by educational level and type of occupation, before and after diagnosis were compared using t-tests. Tobit regressions investigated the associations of earnings with individual characteristics. The proportions on SA and/or DP, by educational level and type of occupation, for the diagnosis year and 5 years later were compared.ResultsDifferences in earnings between PwMS and references were observed beginning 1 year before diagnosis, and increased thereafter. PwMS had lower mean earnings for the diagnosis year (difference=SEK 28 000, p<0.05), and 5 years after diagnosis, this difference had more than doubled (p<0.05). These differences remained after including educational level and type of occupation. Overall, the earnings of PwMS with university education and/or more qualified occupations were most like their reference peers. The proportions on SA and DP were higher among PwMS than the references.ConclusionsThe results suggest that the PwMS’ earnings are lower than the references’ beginning shortly before MS diagnosis, with this gap increasing thereafter. Besides SA and DP, the results indicate that educational level and type of occupation are influential determinants of the large heterogeneity of PwMS’ earnings.

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Perinatal Depression and Anxiety in Women with Multiple Sclerosis: A Population-Based Cohort Study

Neurology ◽

10.1212/wnl.0000000000012062 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012062

Author(s):

Karine Eid ◽

Øivind Fredvik Torkildsen ◽

Jan Aarseth ◽

Heidi Øyen Flemmen ◽

Trygve Holmøy ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cohort Study ◽

Symptom Onset ◽

Postpartum Period ◽

Perinatal Depression ◽

Reference Group ◽

Population Based ◽

Psychiatric Disease ◽

Depression And Anxiety ◽

Increased Risk

ObjectiveTo assess the occurrence of perinatal depression and anxiety in women before and after diagnosis of multiple sclerosis (MS).Methods114,629 pregnant women were included in the Norwegian Mother, Father and Child Cohort study 1999–2008. We assessed depression and anxiety by questionnaires during and after pregnancy. Women with MS were identified from national health registries and hospital records and grouped into 1) MS diagnosed before pregnancy (n = 140), MS diagnosed after pregnancy with 2) symptom onset before pregnancy (n = 98) and 3) symptom onset after pregnancy (n = 308). Thirty-five women were diagnosed with MS in the postpartum period. The reference group (n = 111,627) consisted of women without MS.ResultsWomen with MS diagnosed before pregnancy had an adjusted odds ratio of 2.0 (95% confidence interval 1.2–3.1) for depression in the third trimester. Risk factors were adverse socioeconomic factors, history of psychiatric disease and physical/sexual abuse. The risk of anxiety was not increased. Women diagnosed with MS in the postpartum period had especially high risk of postpartum depression. Women with MS symptom onset within 5 years after pregnancy had increased risk of both depression and anxiety during pregnancy, whereas women with more than 5 years until symptom onset did not.ConclusionWomen diagnosed with MS have increased risk of perinatal depression. Women with MS symptom onset within 5 years after pregnancy have increased risk of both depression and anxiety during pregnancy.

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Exercise and the Risk of Dementia in Patients with Newly Diagnosed Atrial Fibrillation: A Nationwide Population-Based Study

Journal of Clinical Medicine ◽

10.3390/jcm10143126 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3126

Author(s):

Jaehyun Lim ◽

So-Ryoung Lee ◽

Eue-Keun Choi ◽

Kyung-Do Han ◽

Jin-Hyung Jung ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Reduction ◽

Lower Risk ◽

Population Based ◽

Newly Diagnosed ◽

Incident Dementia ◽

Before And After ◽

Korean National Health Insurance ◽

New Diagnosis ◽

New Onset

Background: It is unclear whether exercise would reduce dementia in patients with a new diagnosis of atrial fibrillation (AF). Therefore, we aimed to evaluate the association between the change in physical activity (PA) before and after new-onset AF and the risk of incident dementia. Methods: Using the Korean National Health Insurance Service database, we enrolled a total of 126,555 patients with newly diagnosed AF between 2010 and 2016, who underwent health examinations within two years before and after their diagnosis of AF. The patients were divided into four groups: persistent non-exercisers, exercise starters, exercise quitters, and exercise maintainers. Results: Based on a total of 396,503 person-years of follow-up, 5943 patients were diagnosed with dementia. Compared to persistent non-exercisers, exercise starters (adjusted hazard ratio (aHR) 0.87; 95% confidence interval (CI) 0.81–0.94), and exercise maintainers (aHR 0.66; 95% CI 0.61–0.72) showed a lower risk of incident dementia; however, the risk was similar in exercise quitters (aHR 0.98; 95% CI 0.92–1.05) (p-trend < 0.001). There was a J-shaped relationship between the dose of exercise and the risk of dementia, with the risk reduction maximized at 5–6 times per week of moderate-to-vigorous PA among exercise starters. Conclusion: Patients who initiated or continued regular exercise after diagnosis of AF were associated with a lower risk of dementia than persistent non-exercisers, with no risk reduction associated with exercise cessation. Our findings may provide evidence for the benefit of exercise prescription to patients with new-onset AF to prevent incident dementia regardless of their current exercise status.

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Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study

Scientific Reports ◽

10.1038/s41598-021-91356-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sze-Wen Ting ◽

Sze-Ya Ting ◽

Yu-Sheng Lin ◽

Ming-Shyan Lin ◽

George Kuo

Keyword(s):

Cohort Study ◽

Herpes Zoster ◽

Population Based ◽

Research Database ◽

Newly Diagnosed ◽

Increased Risk ◽

Taiwan National Health Insurance ◽

Reduced Risk ◽

Systemic Therapies

AbstractThe incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.

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Use of antibiotics and risk of psychiatric disorders in newly diagnosed cancer patients: a population-based cohort study in Sweden

Cancer Epidemiology Biomarkers & Prevention ◽

10.1158/1055-9965.epi-21-1095 ◽

2022 ◽

pp. cebp.1095.2021

Author(s):

Kejia Hu ◽

Karin E Smedby ◽

Arvid Sjölander ◽

Scott Montgomery ◽

Unnur Valdimarsdóttir ◽

...

Keyword(s):

Cohort Study ◽

Psychiatric Disorders ◽

Cancer Patients ◽

Population Based ◽

Newly Diagnosed

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Divergent patterns of anti-fracture medication use following fracture on therapy: A population-based cohort study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab696 ◽

2021 ◽

Author(s):

Gregory A Kline ◽

Suzanne N Morin ◽

Lisa M Lix ◽

William D Leslie

Keyword(s):

Cohort Study ◽

Medication Adherence ◽

Vertebral Fracture ◽

Drug Efficacy ◽

Population Based ◽

Duration Of Treatment ◽

Traumatic Fracture ◽

Before And After ◽

One Year

Abstract Context Fracture-on-therapy should motivate better anti-fracture medication adherence. Objective Describe osteoporosis medication adherence in women before and following a fracture. Design Retrospective cohort study. Setting Manitoba BMD Registry (1996-2013). Patients Women who started anti-fracture drug therapy after a DXA-BMD with follow-up for 5 years during which a non-traumatic fracture occurred at least one year after starting treatment. Main Outcome Linked prescription records determined medication adherence (estimated by medication possession ratios, MPR) in one-year intervals. The variable of interest was MPR in the year before and after the year in which the fracture occurred with subgroup analyses according to duration of treatment pre-fracture. We chose an MPR of ≥0.50 to indicate minimum adherence needed for drug efficacy. Results There were 585 women with fracture-on-therapy, 193(33%) had hip or vertebral fracture. Bisphosphonates accounted for 82.2% of therapies. Median MPR the year prior to fracture was 0.89(IQR 0.49-1.0) and 0.69(IQR 0.07-0.96) the year following the year of fracture(p< 0.0001). The percentage of women with MPR ≥ 0.5 pre-fracture was 73.8%, dropping to 57.3% post-fracture(p<0.0001); restricted to hip/vertebral fracture results were similar (58.2% to 33.3%, p <0.002). Among those with pre-fracture MPR <0.5, only 21.7% achieved a post-fracture MPR ≥ 0.5. Conclusions Although fracture-on-therapy may motivate sustained/improved adherence, MPR remains low or even declines after fracture in many. This could reflect natural decline in MPR with time but is paradoxical to expectations. Fracture-on-therapy represents an important opportunity for clinicians to re-emphasize treatment adherence.

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