Imperial College
Primary Care and Public Health

Author Of 1 Presentation

Comorbidities Poster Presentation

P0433 - Association between MS and depression on the risk of macrovascular disease and mortality in England: a population-based matched cohort study (ID 1262)

Speakers
Presentation Number
P0433
Presentation Topic
Comorbidities

Abstract

Background

Depression is associated with an increased risk of macrovascular disease and mortality in the general population. Depression is also the most frequent comorbidity in people with multiple sclerosis (PWMS); however, it is unknown whether it might disproportionally affect the risk of vascular disease and all-cause mortality in PWMS as compared with the general population.

Objectives

Assess whether the association between depression, vascular disease, and mortality differs in PWMS as compared with the general population.

Methods

Population-based retrospective matched cohort study, which included PWMS diagnosed between 1-Jan 1987 and 30-Sep 2018 and registered with general practices in England, and up to 6 controls matched by age, sex, and general practice. We used Cox proportional hazard regression models to assess differences in the risk of any macrovascular disease (acute coronary syndrome, cerebrovascular,and peripheral arterial disease) and mortality. We included an interaction term between MS status and depression in the model. Covariates included sex, age, ethnicity, smoking status, diabetes, treatment with antidiabetic, anti-hypertensive, antilipid, anti-platelet, and anti-coagulant medications, deprivation index, number of primary care visits, and MS diagnosis year. Analyses were also stratified by sex. We present results as adjusted hazard ratios (HR), attributable proportion due to interaction (API), and 95% confidence intervals (95%CI).

Results

We matched 12,251 PWMS to 72,572 controls. 21% (2535) PWMS and 8.7% (6,278) controls had a depression diagnosis at index year. As compared with controls without depression, risk of any macrovascular disease was greater in controls with depression (HR 2.93, 95%CI 2.53-3.40), greater in PWMS without depression (HR 1.38, 95%CI 1.17-1.62), and greater in PWMS with depression (HR 3.53, 95%CI 2.83-4.40). Mortality risk was greater in controls with depression (HR 1.74, 95%CI 1.60-1.90), greater in PWMS without depression (HR 3.59, 95%CI 3.39-3.81), and 5-fold greater in PWMS with depression (HR 4.99, 95%CI 4.53-5.50). 13% of the combined effect of MS and depression on mortality was due to interaction (API 0.13, 95%CI 0.04-0.22). Differences were greater in men.

Conclusions

Depression is associated with increased risk of macrovascular disease and mortality in PWMS. The effect of depression and MS on mortality risk is synergistic overall and offers a clear treatment opportunity which is likely to be under-utilised.

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Presenter Of 1 Presentation

Comorbidities Poster Presentation

P0433 - Association between MS and depression on the risk of macrovascular disease and mortality in England: a population-based matched cohort study (ID 1262)

Speakers
Presentation Number
P0433
Presentation Topic
Comorbidities

Abstract

Background

Depression is associated with an increased risk of macrovascular disease and mortality in the general population. Depression is also the most frequent comorbidity in people with multiple sclerosis (PWMS); however, it is unknown whether it might disproportionally affect the risk of vascular disease and all-cause mortality in PWMS as compared with the general population.

Objectives

Assess whether the association between depression, vascular disease, and mortality differs in PWMS as compared with the general population.

Methods

Population-based retrospective matched cohort study, which included PWMS diagnosed between 1-Jan 1987 and 30-Sep 2018 and registered with general practices in England, and up to 6 controls matched by age, sex, and general practice. We used Cox proportional hazard regression models to assess differences in the risk of any macrovascular disease (acute coronary syndrome, cerebrovascular,and peripheral arterial disease) and mortality. We included an interaction term between MS status and depression in the model. Covariates included sex, age, ethnicity, smoking status, diabetes, treatment with antidiabetic, anti-hypertensive, antilipid, anti-platelet, and anti-coagulant medications, deprivation index, number of primary care visits, and MS diagnosis year. Analyses were also stratified by sex. We present results as adjusted hazard ratios (HR), attributable proportion due to interaction (API), and 95% confidence intervals (95%CI).

Results

We matched 12,251 PWMS to 72,572 controls. 21% (2535) PWMS and 8.7% (6,278) controls had a depression diagnosis at index year. As compared with controls without depression, risk of any macrovascular disease was greater in controls with depression (HR 2.93, 95%CI 2.53-3.40), greater in PWMS without depression (HR 1.38, 95%CI 1.17-1.62), and greater in PWMS with depression (HR 3.53, 95%CI 2.83-4.40). Mortality risk was greater in controls with depression (HR 1.74, 95%CI 1.60-1.90), greater in PWMS without depression (HR 3.59, 95%CI 3.39-3.81), and 5-fold greater in PWMS with depression (HR 4.99, 95%CI 4.53-5.50). 13% of the combined effect of MS and depression on mortality was due to interaction (API 0.13, 95%CI 0.04-0.22). Differences were greater in men.

Conclusions

Depression is associated with increased risk of macrovascular disease and mortality in PWMS. The effect of depression and MS on mortality risk is synergistic overall and offers a clear treatment opportunity which is likely to be under-utilised.

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