Epidemiology Poster Presentation

P0426 - A systematic assessment of medical diseases and symptoms preceding the first diagnosis of multiple sclerosis (ID 1159)

Speakers
  • C. Gasperi
Authors
  • C. Gasperi
  • A. Hapfelmeier
  • T. Daltrozzo
  • E. Donnachie
  • A. Schneider
  • B. Hemmer
Presentation Number
P0426
Presentation Topic
Epidemiology

Abstract

Background

Previous studies reported that patients who were later diagnosed with multiple sclerosis (MS) showed an altered behavior regarding the use of the healthcare system including increased rates of physician and hospital encounters related to neurological, musculoskeletal and genitourinary as well as psychiatric symptoms up to 10 years before first diagnosis.

Objectives

To explore the occurrence of diseases and symptoms in the 5-year period prior to first diagnosis in patients with multiple sclerosis (MS).

Methods

Using ambulatory claims data we systematically assessed differences in the occurrence of diseases and symptoms in the five years prior to first diagnosis in patients with MS (n=10,524) as compared to patients newly diagnosed with two other autoimmune diseases – Crohn’s disease (n=15,943) and psoriasis (n=99,027) - and individuals without any of these diseases (n=73,430).

Results

Forty-three ICD-10 codes were recorded significantly more frequently for patients with MS in the five years before first diagnosis as compared to controls without autoimmune disease. Many of these findings were confirmed in a comparison to the other two control groups. A high proportion of these ICD-10 codes represent symptoms suggestive of a demyelinating event or other neurological diagnoses. Additionally, six psychiatric diagnoses were recorded more frequently for patients with MS as compared to controls. In a sensitivity analysis excluding patients with symptoms suggestive of an MS relapse or any recordings for neurological diseases prior to first diagnosis, none of these associations remained significant. Six ICD-10 codes were significantly and negatively associated with MS, four of which represented infections of the upper respiratory tract. Here, the negative relations with MS were even more pronounced in the sensitivity analysis.

Conclusions

Our analyses suggest that most of the ICD-10 codes recorded more frequently prior to MS diagnosis are related to misdiagnosed demyelinating events and therefore delayed diagnosis. Other ICD-10 codes more frequently recorded for patients with MS - although not in the sensitivity analysis - included psychiatric diagnoses, which is in accordance with previous studies that report psychiatric disorders as frequent comorbidities in patients with MS. The robust negative association of upper respiratory tract infections with MS diagnosis suggests a link between protection from infection and the occurrence of MS.

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