Care consumption of people with multiple sclerosis: A multichannel sequence analysis in a population-based setting in British Columbia, Canada

Background: Persons with multiple sclerosis (PwMS) typically require complex multidisciplinary care, which is rarely formally assessed. Objectives: We applied multichannel sequence analysis (MCSA) to identify care consumption patterns by PwMS in British Columbia, Canada. Methods: We created two cohorts, comprising incident and prevalent MS cases, using linked clinical and administrative data. We applied MCSA to quantify and compare the care pathways of PwMS, based on all-cause hospitalizations and physician visits (divided into five specialities). Care consumption clusters were characterized using demographic and clinical features. Results: From 1048 incident and 3180 prevalent PwMS, the MCSA identified 12 and 6 distinct care consumption clusters over a median follow-up of 9.6 and 13.0 years, respectively. Large disparities between clusters were observed; the median number of annual consultations ranged from 5.6 to 21.3 for general practitioners, 1.2 to 4.6 for neurologists and 0 to 5.3 for psychiatrists in the incident cohort. Characteristics at MS symptom onset associated with the highest care consumption included high comorbidity burden and older age. There were similar disparities and associations for prevalent PwMS. Conclusion: The distinct patterns of care consumption, which were reminiscent of the heterogeneity of MS itself, may facilitate health service planning and evaluation, and provide a novel outcome measure in health research.

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Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217320947761 ◽

2020 ◽

Vol 6 (3) ◽

pp. 205521732094776

Author(s):

Anna Castelo-Branco ◽

Flaminia Chiesa ◽

Camilla E Bengtsson ◽

Sally Lee ◽

Neil N Minton ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cohort Study ◽

Improve Patient Care ◽

Bowel Dysfunction ◽

Population Based ◽

Incidence Rates ◽

Swedish Population ◽

Comorbidity Burden ◽

National Cohort ◽

Rate Ratios

Background Comorbidity is of significant concern in multiple sclerosis (MS). Few population-based studies have reported conditions occurring in MS after diagnosis, especially in contemporary cohorts. Objective To explore incident comorbidity, mortality and hospitalizations in MS, stratified by age and sex. Methods In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years) and 61,828 matched MS-free individuals were identified between 1 January 2008 and 31 December 2016, using national registers. Incidence rates (IRs) and incidence rate ratios (IRRs) with 95% CI were calculated for each outcome. Results IRs of cardiovascular disease (CVD) were higher among MS patients than MS-free individuals, (major adverse CVD: IRR 1.42; 95% CI 1.12–1.82; hemorrhagic/ischemic stroke: 1.46; 1.05–2.02; transient ischemic attack: 1.65; 1.09–2.50; heart failure: 1.55; 1.15–2.10); venous thromboembolism: 1.42; 1.14–1.77). MS patients also had higher risks of several non-CVDs such as autoimmune conditions (IRR 3.83; 3.01–4.87), bowel dysfunction (2.16; 1.86–2.50), depression (2.38; 2.11–2.68), and fractures (1.32; 1.19–1.47), as well as being hospitalized and to suffer from CVD-related deaths ((1.91; 1.00–3.65), particularly in females (3.57; 1.58–8.06)). Conclusion MS-patients experience a notable comorbidity burden which emphasizes the need for integrated disease management in order to improve patient care and long-term outcomes of MS.

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Infection-related health care utilization among people with and without multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458516681198 ◽

2016 ◽

Vol 23 (11) ◽

pp. 1506-1516 ◽

Cited By ~ 25

Author(s):

José MA Wijnands ◽

Elaine Kingwell ◽

Feng Zhu ◽

Yinshan Zhao ◽

John D Fisk ◽

...

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Health Care Utilization ◽

Age Groups ◽

Population Based ◽

Care Utilization ◽

Prescription Data ◽

Physician Visits ◽

Intestinal Infections ◽

Adjusted Rate

Background: Little is known about infection risk in multiple sclerosis (MS). Objective: We examined infection-related health care utilization in people with and without MS. Methods: Using population-based health administrative data from British Columbia, Canada, people with MS were followed from their first demyelinating claim (1996–2013) until death, emigration, or study end (2013). Infection-related hospital, physician, and prescription data of MS cases were compared with sex-, age-, and geographically matched controls using adjusted regression models. Sex and age differences (18–39, 40–49, 50–59, 60+ years) were explored. Results: Relative to 35,837 controls, 7179 MS cases were over twice as likely to be hospitalized for infection (adjusted odds ratio: 2.39; 95% confidence interval (CI): 2.16–2.65), had 41% more physician visits (adjusted rate ratio (aRR): 1.41; 95% CI: 1.36–1.47), and filled 57% more infection-related prescriptions (aRR: 1.57; 95% CI: 1.49–1.65). Utilization was disproportionately higher in MS men than women and was elevated across all ages. MS cases had nearly twice as many physician visits and two to three times more hospitalizations for pneumonia, urinary system infections, and skin infections (aRRs ranged from 1.6 to 3.3) and over twice as many hospitalizations for intestinal infections (aRR = 2.6) and sepsis (aRR = 2.2). Conclusion: Infection-related health care utilization was increased in people with MS across all age groups, with a higher burden for men.

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An assessment of the spectrum of disability and handicap in multiple sclerosis: a population-based study

Multiple Sclerosis Journal ◽

10.1177/135245850100700207 ◽

2001 ◽

Vol 7 (2) ◽

pp. 111-117 ◽

Cited By ~ 33

Author(s):

G V McDonnell ◽

S A Hawkins

Keyword(s):

Multiple Sclerosis ◽

Social Issues ◽

Population Based ◽

Community Services ◽

Service Planning ◽

Standards Of Care ◽

Full Time ◽

North East ◽

The North ◽

Environmental Status

Objectives: To establish the spectrum of disability and handicap in a population based sample of multiple sclerosis (MS) patients. Background: Much knowledge exists about the epidemiology of MS but, despite its importance for health and social service planning, there remains relatively little data on the extent and nature of disability and handicap in this population. Methods: In a prevalence study in the north-east of N. Ireland, 288 patients (Poser criteria) were identified. Disability and handicap were assessed using the Incapacity Status Scale and Environmental Status Scale of the Minimal Record of Disability for MS. Results: Both scales were completed for 248 (86%) of patients. Just 71 (29%) are fully independent in all basic ADL's of bathing, dressing, grooming and feeding. Fifty-seven (23%) are unable to climb a flight of stairs and 102 (42%) acknowledge problems with sexual function. Sixty-one (25%) were working essentially full-time and 53 (21%) had no external financial support. Forty-five (18%) had changed residence due to MS, 12 (5%) were institutionalised and 86 (35%) required assistance for at least 1 h/day with ADL's. Eighty-one (33%) were unable to drive a car or use public transport. Forty-two (17%) access community services for at least 1 h/day on average. Conclusions: This data gives a clear indication of the considerable range of basic health and social issues in a typical MS community. Further work is required to establish patient perceptions of the adequacy of care provision and whether standards of care for MS patients are being met.

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Fatigue, sleep disorders, anaemia and pain in the multiple sclerosis prodrome

Multiple Sclerosis Journal ◽

10.1177/1352458520908163 ◽

2020 ◽

pp. 135245852090816 ◽

Cited By ~ 3

Author(s):

Fardowsa LA Yusuf ◽

José MA Wijnands ◽

Elaine Kingwell ◽

Feng Zhu ◽

Charity Evans ◽

...

Keyword(s):

Multiple Sclerosis ◽

Sleep Disorders ◽

Symptom Onset ◽

Population Based ◽

Matched Cohort ◽

Physician Visits ◽

Clinical Databases ◽

Form Part ◽

Population Controls ◽

Age And Sex

Background: There is increasing evidence of prodromal multiple sclerosis (MS). Objective: The aim of this study was to determine whether fatigue, sleep disorders, anaemia or pain form part of the MS prodrome. Methods: This population-based matched cohort study used linked administrative and clinical databases in British Columbia, Canada. The odds of fatigue, sleep disorders, anaemia and pain in the 5 years preceding the MS cases’ first demyelinating claim or MS symptom onset were compared with general population controls. The frequencies of physician visits for these conditions were also compared. Modifying effects of age and sex were evaluated. Results: MS cases/controls were assessed before the first demyelinating event (6863/31,865) or MS symptom onset (966/4534). Fatigue (adj.OR: 3.37; 95% CI: 2.76–4.10), sleep disorders (adj.OR: 2.61; 95% CI: 2.34–2.91), anaemia (adj.OR: 1.53; 95% CI: 1.32–1.78) and pain (adj.OR: 2.15; 95% CI: 2.03–2.27) during the 5 years preceding the first demyelinating event were more frequent among cases, and physician visits increased for cases relative to controls. The association between MS and anaemia was greater for men; that between MS and pain increased with age. Pre-MS symptom onset, sleep disorders (adj.OR: 1.72; 95% CI: 1.12–2.56) and pain (adj.OR: 1.53; 95% CI: 1.32–1.76) were more prevalent among cases. Conclusion: Fatigue, sleep disorders, anaemia and pain were elevated before the recognition of MS. The relative anaemia burden was higher in men and pain more evident among older adults.

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Days at Home in the Last 6 Months of Life: A Patient-Determined Quality Indicator for Cancer Care

Journal of Oncology Practice ◽

10.1200/jop.18.00338 ◽

2019 ◽

Vol 15 (4) ◽

pp. e308-e315 ◽

Cited By ~ 6

Author(s):

Sarah K. Andersen ◽

Ruth Croxford ◽

Craig C. Earle ◽

Simron Singh ◽

Matthew C. Cheung

Keyword(s):

Administrative Data ◽

Quality Indicator ◽

Large Population ◽

Median Number ◽

Population Based ◽

Cancer Type ◽

Patients With Cancer ◽

Comorbidity Burden ◽

Future Policy ◽

At Home

PURPOSE: Quality end-of-life care (EoLC) is a key aspect of oncology. Days at home in the last 6 months of life represents a novel, patient-driven quality indicator of EoLC. We measured days at home in a large population of patients with cancer in Ontario, Canada. Trends over time and predictors of more or less time at home were also determined. METHODS: We conducted a population-based retrospective study using health administrative data linked by unique, encoded identifiers and analyzed at the ICES. Quantile regression was used to determine significant predictors of more or less time at home. RESULTS: Of 72,987 patients who died of cancer in Ontario, Canada and met our inclusion criteria, the median number of days spent at home in the last 6 months of life was 164 (interquartile range [IQR], 144 to 175 days) of a possible 180 days. Patients with hematologic cancers spent significantly fewer days at home (156; IQR, 134 to 170 days). The strongest predictors of more time at home were male sex (+2.87 days relative to female sex; CI, 2.43 to 3.31 days) and receipt of palliative care before the last 6 months of life (+2.38 days; CI, 1.95 to 2.08 days). Additional predictors included income, age, cancer type, comorbidity burden, and health region. The majority of patients (69.7%) did not die at home. CONCLUSION: Days at home in the last 6 months of life, obtained from administrative data, can be used as a measure of quality EoLC. Predictors of days at home may prove valuable targets for future policy intervention.

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Disease-modifying drugs for multiple sclerosis and subsequent health service use

Multiple Sclerosis Journal ◽

10.1177/13524585211063403 ◽

2021 ◽

pp. 135245852110634

Author(s):

Huah Shin Ng ◽

Feng Zhu ◽

Elaine Kingwell ◽

Yinshan Zhao ◽

Shenzhen Yao ◽

...

Keyword(s):

Multiple Sclerosis ◽

First Generation ◽

Service Use ◽

Second Generation ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Population Based ◽

Disease Modifying Drugs ◽

Physician Visits ◽

Disease Modifying

Objective: We assessed the relationship between the multiple sclerosis (MS) disease-modifying drugs (DMDs) and healthcare use. Methods: Persons with MS (aged ⩾18 years) were identified using linked population-based health administrative data in four Canadian provinces and were followed from the most recent of their first MS/demyelinating event or 1 January 1996 until the earliest of death, emigration, or study end (31 December 2017 or 31 March 2018). Prescription records captured DMD exposure, examined as any DMD, then by generation (first-generation (the injectables) or second-generation (orals/infusions)) and individual DMD. The associations with subsequent all-cause hospitalizations and physician visits were examined using proportional means model and negative binomial regression. Results: Of 35,894 MS cases (72% female), mean follow-up was 12.0 years, with person-years of DMD exposure for any, or any first- or second-generation DMD being 63,290, 54,605 and 8685, respectively. Any DMD or any first-generation DMD exposure (versus non-exposure) was associated with a 24% lower hazard of hospitalization (adjusted hazard ratio, aHR: 0.76; 95% confidence intervals (CIs): 0.71–0.82), rising to 29% for the second-generation DMDs (aHR: 0.71; 95% CI: 0.58–0.88). This ranged from 18% for teriflunomide (aHR: 0.82; 95% CI: 0.67–1.00) to 44% for fingolimod (aHR: 0.56; 95% CI: 0.36–0.87). In contrast, DMD exposure was generally not associated with substantial differences in physician visits. Conclusion: Findings provide real-world evidence of a beneficial relationship between DMD exposure and hospitalizations.

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A population-based study comparing multiple sclerosis clinic users and non-users in British Columbia, Canada

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.30 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Kyla McKay ◽

Helen Tremlett ◽

Feng Zhu ◽

Lorne Kastrukoff ◽

Ruth Ann Marrie ◽

...

Keyword(s):

Multiple Sclerosis ◽

British Columbia ◽

Population Based ◽

Administrative Databases ◽

Limited Information ◽

Publicly Funded ◽

Health Administrative Data ◽

Diagnostic Codes ◽

System A ◽

Disease Modifying Therapy

ABSTRACTObjectivesMuch clinical knowledge about multiple sclerosis (MS) has been gained from patients who attend MS specialty clinics. However, there is limited information about whether these patients are representative of the wider MS population. The objective of this study was to compare incident MS cases who were MS clinic users to non-users of the specialty MS clinics in British Columbia, Canada. ApproachThis was a retrospective record linkage cohort study using prospectively collected data from the BCMS database and province-wide health administrative databases. Incident MS cases were identified in the general population using a validated algorithm of hospital and physician diagnostic codes. Results There were 2,841 incident MS cases between 1996 and 2004 including 1,648 (58%) that had registered at an MS clinic (‘clinic cases’) and 1,193 (42%) that had not (‘non-clinic cases’). Sex and socioeconomic status distributions were similar; however, non-clinic cases were older, accessed health services more frequently, and had a higher burden of comorbidity than clinic cases. Only 1% of the non-clinic cases had filled a prescription for an MS-specific disease-modifying therapy, compared to 51% of the clinic cases. ConclusionOur findings have several important implications: even within a publicly funded healthcare system, a high proportion of individuals with MS may not access a specialty MS clinic; the needs of MS patients managed in the community may differ from those referred to an MS clinic; findings from studies involving clinic-based MS cohorts may not always be generalizable to the wider MS population; and access to population-based health administrative data offers the opportunity to gain a broader understanding of MS.

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Diagnosed Incidence of Non-Affective Psychotic Disorders Amongst Adolescents in British Columbia and Sociodemographic Risk Factors: A Retrospective Cohort Study

The Canadian Journal of Psychiatry ◽

10.1177/07067437211055412 ◽

2021 ◽

pp. 070674372110554

Author(s):

Carly Magee ◽

Martin Guhn ◽

Joseph H. Puyat ◽

Anne Gadermann ◽

Eva Oberle

Keyword(s):

British Columbia ◽

Health Service ◽

Incidence Rate ◽

Psychotic Disorder ◽

Low Income ◽

Cumulative Incidence ◽

Service Planning ◽

Entire Study ◽

Physician Visits ◽

Service Engagement

Objectives To estimate the diagnosed incidence of non-affective psychotic disorder between the ages of 13 and 19 years in South-Western British Columbia (BC) and to examine variation in risk by sex, family and neighbourhood income, family migration background, parent mental health contact and birth year. Methods Linked individual-level administrative data were used to construct a cohort of individuals born in 1990–1998 and residing in South-Western BC ( n = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits within 2 years with a primary diagnosis of a non-affective psychotic disorder (ICD-10: F20–29, ICD-9: 295, 297, 298). We estimated cumulative incidence, annual cumulative incidence and incidence rate between the ages of 13 and 19 years, and conducted Cox proportional hazards regression to estimate associations between sociodemographic factors and risk over the study period. Results We found that 0.64% of females and 0.88% of males were diagnosed with a non-affective psychotic disorder between the ages of 13 and 19 years, with increasing risk observed over the age range, especially amongst males. Incidence rate over the entire study period was 106 per 100,000 person-years for females and 145 per 100,000 person-years for males. Risk of diagnosis was elevated amongst those in low-income families and neighbourhoods, those with a parent who had a health service contact for a mental disorder, and more recent birth cohorts. Risk was reduced amongst children of immigrants compared to children of non-migrants. Conclusions Findings from this study provide important information for health service planning in South-Western BC. Future work should examine whether variations in diagnosed incidence is driven by differences in health service engagement or reflect genuine differences in risk.

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Toxoplasma gondii and multiple sclerosis: a population-based case–control study

Scientific Reports ◽

10.1038/s41598-020-75830-y ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Alessandra Nicoletti ◽

Calogero Edoardo Cicero ◽

Loretta Giuliano ◽

Valeria Todaro ◽

Salvatore Lo Fermo ◽

...

Keyword(s):

Multiple Sclerosis ◽

Toxoplasma Gondii ◽

Educational Level ◽

Population Based ◽

Protective Role ◽

Parasitic Infections ◽

High Educational Level ◽

Inverse Association ◽

Incident Cohort ◽

High Educational

Abstract According to the hygiene hypothesis, parasites could have a protective role in the development of Multiple Sclerosis (MS). Our aim was to assess the association between presence of anti-Toxoplasma gondii antibodies and MS. MS patients were randomly selected from a population-based incident cohort of MS patients in the city of Catania. Age and sex-matched controls were randomly selected from the general population. Clinical and sociodemographic variables were recorded with a structured questionnaire and a blood sample was taken for serological analysis. Specific T. gondii IgG have been detected with a commercial kit. Adjusted Odds Ratios (ORs) were estimated using unconditional logistic regression. 129 MS subjects (66.7% women with a mean age 44.7 ± 11.0 years) and 287 controls (67.3% women with a mean age 48.1 ± 15.6 years) have been enrolled in the study. Anti-T. gondii antibodies were found in 38 cases (29.5%) and 130 controls (45.4%) giving an adjusted OR of 0.56 (95%CI 0.34–0.93). History of mononucleosis and high educational level were significantly associated with MS (adjOR 2.22 and 1.70 respectively) while an inverse association was found between high educational level and T. gondii seropositivity (adjOR 0.42). Our results further support the protective role of parasitic infections in MS.

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