From the Danish Multiple Sclerosis Center (A.T., P.S.S., M.M.), Department of Neurology, University of Copenhagen, Rigshospitalet; The Danish Multiple Sclerosis Registry (A.T., N.K.-H., M.M.), Department of Neurology, Rigshospitalet, Copenhagen; Department of Clinical Epidemiology (N.K.-H.), Clinical Institute, University of Aarhus; and The Danish National Institute of Public Health (B.L.), University of Southern Denmark, Copenhagen.
Neurology. 2017 Oct 17;89(16):1668-1675. doi: 10.1212/WNL.0000000000004508. Epub 2017 Sep 20.
To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS.
We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of diagnosis, we compared individuals with and without chronic comorbidity using multinomial logistic regression. To investigate mortality, we used Cox regression with time-dependent covariates, following study participants from clinical MS onset until endpoint (death) or to the end of the study, censuring at emigration.
We identified 8,947 individuals with clinical onset of MS between 1980 and 2005. In the study of time of diagnosis, we found statistically significant odds ratios for longer diagnostic delays with cerebrovascular comorbidity (2.01 [1.44-2.80]; <0.0005), cardiovascular comorbidity (4.04 [2.78-5.87]; <0.0005), lung comorbidity (1.93 [1.42-2.62]; <0.0005), diabetes comorbidity (1.78 [1.04-3.06]; 0.035), and cancer comorbidity (2.10 [1.20-3.67]; 0.009). In the mortality study, we found higher hazard ratios with psychiatric comorbidity (2.42 [1.67-3.01]; <0.0005), cerebrovascular comorbidity (2.47 [2.05-2.79]; <0.0005), cardiovascular comorbidity (1.68 [1.39-2.03]; <0.0005), lung comorbidity (1.23 [1.01-1.50]; 0.036), diabetes comorbidity (1.39 [1.05-1.85]; 0.021), cancer comorbidity (3.51 [2.94-4.19]; <0.0005), and Parkinson disease comorbidity (2.85 [1.34-6.06]; 0.007).
An increased awareness of both the necessity of neurologic evaluation of new neurologic symptoms in persons with preexisting chronic disease and of optimum treatment of comorbidity in MS is critical.
探讨慢性合并症对多发性硬化症（MS）诊断时间和 MS 死亡率的影响。
我们进行了一项基于人群的全国性队列研究，纳入了 1980 年至 2005 年间丹麦所有首发 MS 症状的 MS 病例。为了研究诊断时间，我们使用多项逻辑回归比较了有和无慢性合并症的个体。为了研究死亡率，我们使用了时间依赖性协变量的 Cox 回归，对临床 MS 发病的研究参与者进行随访，直至终点（死亡）或研究结束，对移民进行censoring。
我们确定了 1980 年至 2005 年间临床发病的 8947 名 MS 患者。在诊断时间的研究中，我们发现脑血管合并症（2.01 [1.44-2.80]；<0.0005）、心血管合并症（4.04 [2.78-5.87]；<0.0005）、肺部合并症（1.93 [1.42-2.62]；<0.0005）、糖尿病合并症（1.78 [1.04-3.06]；0.035）和癌症合并症（2.10 [1.20-3.67]；0.009）的诊断延迟时间有统计学显著的比值比。在死亡率研究中，我们发现精神合并症（2.42 [1.67-3.01]；<0.0005）、脑血管合并症（2.47 [2.05-2.79]；<0.0005）、心血管合并症（1.68 [1.39-2.03]；<0.0005）、肺部合并症（1.23 [1.01-1.50]；0.036）、糖尿病合并症（1.39 [1.05-1.85]；0.021）、癌症合并症（3.51 [2.94-4.19]；<0.0005）和帕金森病合并症（2.85 [1.34-6.06]；0.007）的风险比更高。
提高对有预先存在的慢性疾病的新发神经系统症状患者进行神经学评估的必要性以及对 MS 合并症进行最佳治疗的认识至关重要。
