Toliver Joshua C, Barner Jamie C, Lawson Kenneth A, Rascati Karen L
The University of Texas at Austin, College of Pharmacy, Health Outcomes Division, 2409 University Avenue, STOP, Austin, TX A1930, United States.
Mult Scler Relat Disord. 2021 Apr;49:102741. doi: 10.1016/j.msard.2021.102741. Epub 2021 Jan 7.
BACKGROUND/OBJECTIVE: To compare algorithm determined disease severity, risk of multiple sclerosis (MS) relapse, and MS-related hospitalization between the age-eligible and disability-eligible MS Medicare populations.
Using the Humana claims dataset (2013 - 2015), patients were divided into Medicare age-eligible and disability-eligible groups. A previously developed algorithm, which used MS symptoms and healthcare utilization to categorize MS disease severity into three groups (low, moderate, high) at baseline was employed. Flexible parametric and Cox proportional hazard models were used to estimate the risk for MS relapses and MS-related hospitalizations among the MS disease severity groups and the two eligibility cohorts in the follow-up period.
Of the overall sample (N = 6,559), the majority (N = 4,813, 73.4%) were disability-eligible and in the low disease severity group (N = 4,468, 68.1%). In 10 of 16 disease severity algorithm predictors, the prevalence of these predictors was significantly (p<0.001) higher in the disability-eligible group compared to the age-eligible group. Survival analyses revealed that the disability-eligible group had a significantly higher risk for follow-up MS relapses and follow-up MS-related hospitalizations (HR = 1.79 [CI 1.54 - 2.08] and HR = 1.38 [CI 1.11-1.72], respectively) compared to those in the age-eligible group. When both eligibility and disease severity were considered in the model increases in hazard ratios corresponded generally to increases in disease severity. However, the type of Medicare eligibility does not appear to have a clear pattern across MS disease severity groups for either MS relapse or hospitalizations, CONCLUSION: The disability-eligible Medicare population had a significantly higher prevalence of MS comorbidities and higher MS severity scores at baseline. In addition, they had a higher risk for MS-related relapses and MS-related hospitalizations in the follow-up period. It is important to account for disability status when assessing disease severity and healthcare utilization.
背景/目的：比较符合年龄标准和符合残疾标准的多发性硬化症（MS）医疗保险人群中，通过算法确定的疾病严重程度、MS复发风险和与MS相关的住院情况。
利用Humana索赔数据集（2013 - 2015年），将患者分为符合医疗保险年龄标准组和符合残疾标准组。采用先前开发的一种算法，该算法在基线时使用MS症状和医疗保健利用情况将MS疾病严重程度分为三组（低、中、高）。在随访期内，使用灵活参数模型和Cox比例风险模型来估计MS疾病严重程度组以及两个符合标准队列中MS复发和与MS相关住院的风险。
在总体样本（N = 6559）中，大多数（N = 4813，73.4%）符合残疾标准且处于疾病严重程度低分组（N = 4468，68.1%）。在16个疾病严重程度算法预测指标中的10个指标上，与符合年龄标准组相比，符合残疾标准组中这些预测指标的患病率显著更高（p<0.001）。生存分析显示，与符合年龄标准组相比，符合残疾标准组在随访期内MS复发和与MS相关住院的风险显著更高（风险比分别为1.79 [可信区间1.54 - 2.08]和1.38 [可信区间1. — 1.72]）。当在模型中同时考虑符合标准情况和疾病严重程度时，风险比的增加通常与疾病严重程度的增加相对应。然而，对于MS复发或住院情况，医疗保险符合标准类型在MS疾病严重程度组中似乎没有明显模式。
符合残疾标准的医疗保险人群在基线时MS合并症的患病率显著更高，MS严重程度评分也更高。此外，他们在随访期内与MS相关的复发和与MS相关的住院风险更高。在评估疾病严重程度和医疗保健利用情况时，考虑残疾状况很重要。
