Tinghög Petter, Björkenstam Charlotte, Carstensen John, Jansson Catarina, Glaser Anna, Hillert Jan, Alexanderson Kristina
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
BMC Neurol. 2014 Jun 3;14:117. doi: 10.1186/1471-2377-14-117.
Multiple sclerosis (MS) is a chronic and often disabling disease. In 2005, 62% of the MS patients in Sweden aged 16-65 years were on disability pension. The objective of this study is to investigate whether the presence of common co-morbidities increase MS patients' risk for disability pension.
This population-based cohort study included 4 519 MS patients and 4 972 174 non-MS patients who in 2005 were aged 17-64 years, lived in Sweden, and were not on disability pension. Patients with MS were identified in the nationwide in- and outpatient registers, while four different registers were used to construct three sets of measures of musculoskeletal, mental, and cardiovascular disorders. Time-dependent proportional hazard models with a five-year follow up were performed, adjusting for socio-demographic factors.
All studied disorders were elevated among MS patients, regardless of type of measure used. MS patients with mental disorders had a higher risk for disability pension than MS patients with no such co-morbidities. Moreover, mental disorders had a synergistic influence on MS patients' risk for disability pension. These findings were also confirmed when conducting sensitivity analyses. Musculoskeletal disorders appeared to increase MS patients' risk for disability pension. The results with regard to musculoskeletal disorders' synergistic influence on disability pension were however inconclusive. Cardiovascular co-morbidity had no significant influence on MS-patients' risk for disability pension.
Co-morbidities, especially mental disorders, significantly contribute to MS patients' risk of disability pension, a finding of relevance for MS management and treatment.
多发性硬化症（MS）是一种慢性且通常会导致残疾的疾病。2005年，瑞典16 - 65岁的MS患者中有62%领取了残疾抚恤金。本研究的目的是调查常见合并症的存在是否会增加MS患者领取残疾抚恤金的风险。
这项基于人群的队列研究纳入了4519例MS患者和4972174例非MS患者，这些患者在2005年年龄为17 - 64岁，居住在瑞典，且未领取残疾抚恤金。MS患者是在全国范围内的门诊和住院登记中识别出来的，而使用了四个不同的登记册来构建三组肌肉骨骼、精神和心血管疾病的测量指标。进行了为期五年随访的时间依赖性比例风险模型分析，并对社会人口学因素进行了调整。
无论使用何种测量类型，所有研究的疾病在MS患者中均有所升高。患有精神障碍的MS患者比没有此类合并症的MS患者领取残疾抚恤金的风险更高。此外，精神障碍对MS患者领取残疾抚恤金的风险有协同影响。在进行敏感性分析时，这些发现也得到了证实。肌肉骨骼疾病似乎增加了MS患者领取残疾抚恤金的风险。然而，关于肌肉骨骼疾病对残疾抚恤金协同影响的结果尚无定论。心血管合并症对MS患者领取残疾抚恤金的风险没有显著影响。
合并症，尤其是精神障碍，显著增加了MS患者领取残疾抚恤金的风险，这一发现对MS的管理和治疗具有重要意义。
