Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
Mult Scler Relat Disord. 2020 Feb;38:101511. doi: 10.1016/j.msard.2019.101511. Epub 2019 Nov 6.
We assessed whether clinical characteristics and health-related quality of life (HRQOL) are independently associated with subsequent hospitalizations and physician visits among children with multiple sclerosis (MS); and whether differences in HRQOL account for differences in physician visits between children with MS, monophasic acquired demyelinating syndromes (ADS) and healthy children.
We used linked administrative (health) data from Ontario, Canada and data from a prospective cohort study including HRQOL (measured using the PedsQL), age, sex, cognitive function (accuracy and response time as assessed by Penn Neurocognitive Battery), number of relapses, and neurologic abnormalities on examination. We used generalized linear models with generalized estimating equations to examine factors associated with hospitalizations and ambulatory physician visit rates following each HRQOL assessment, adjusting for age, sex, and socioeconomic status.
We included 36 children with MS, 43 with monophasic ADS and 43 healthy controls. Among children with MS, more relapses were associated with increased odds of hospitalization (odds ratio 1.59; 1.18-2.14); better cognitive accuracy scores were associated with fewer physician visits (rate ratio [RR] 0.68; 0.47-0.98). Children with MS had higher rates of physician visits than healthy children (RR 1.44; 1.00-2.08), unlike children with a monophasic ADS, but HRQOL scores did not account for these differences.
Within the MS population, more relapses are associated with increased odds of hospitalization while better cognitive performance is associated with reduced rates of physician visits. Differences in HRQOL do not account for differences in physician visits by children with MS as compared to healthy children.
我们评估了多发性硬化症（MS）患儿的临床特征和健康相关生活质量（HRQOL）是否与随后的住院和就诊次数独立相关；以及 MS 患儿、单相获得性脱髓鞘综合征（ADS）患儿和健康儿童之间的就诊次数差异是否与 HRQOL 差异有关。
我们使用来自加拿大安大略省的链接行政（健康）数据和一项前瞻性队列研究的数据，该研究包括 HRQOL（使用 PedsQL 进行测量）、年龄、性别、认知功能（通过 Penn 神经认知电池评估的准确性和反应时间）、复发次数以及体格检查中的神经异常。我们使用广义线性模型和广义估计方程来检查与每次 HRQOL 评估后住院和门诊就诊率相关的因素，调整年龄、性别和社会经济地位。
我们纳入了 36 名 MS 患儿、43 名单相 ADS 患儿和 43 名健康对照。在 MS 患儿中，更多的复发与住院的几率增加相关（比值比 1.59；1.18-2.14）；更好的认知准确性评分与较少的就诊次数相关（比率比 [RR] 0.68；0.47-0.98）。MS 患儿的就诊率高于健康儿童（RR 1.44；1.00-2.08），与单相 ADS 患儿不同，但 HRQOL 评分并不能解释这些差异。
在 MS 人群中，更多的复发与住院几率增加相关，而更好的认知表现与就诊次数减少相关。与健康儿童相比，MS 患儿的 HRQOL 差异并不能解释他们就诊次数的差异。
