Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States.
Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States; Yale University School of Medicine, New Haven, CT, United States.
Clin Neurol Neurosurg. 2023 Sep;232:107851. doi: 10.1016/j.clineuro.2023.107851. Epub 2023 Jun 25.
To identify the burden of hospitalization and common primary admitting diagnoses among MS patients in the United States (US).
The burden of hospitalizations and conditions leading to hospitalizations in MS patients in the US has not been well described.
DESIGN/METHODS: Using the Nationwide Inpatient Sample for 2001-2010, all patients with principal or secondary diagnosis of MS were identified, and the principal admitting diagnoses were compared with that of non-MS patients. Trends in hospitalizations were studied in specific age groups (1-9 yrs, 10-19 yrs, 20-29 yrs, 30-39 yrs, 40-49 yrs, 50-59 yrs, 60-69 yrs,70-79 yrs, 80-84 yrs and ≥85 yrs), and population level rates were obtained and compared with non-MS patients to obtain rate ratios (RR) and odds ratios (OR).
A total of 1,240,410 MS patients were identified representing 4 out of every 1000 US hospital admissions, with an estimated female/male ratio of 2.72/1. The median age for MS hospitalizations was 53 years (Interquartile range=18). The majority of all MS hospitalizations occurred in the 30-69-year age bracket (82.17 %). The average length of in-patient hospital stays for MS patients compared to the non-MS population was 5.8 vs. 4.5 days (p < 0.001), and more MS patients had Medicare insurance (50.36 % vs. 42.24 %, p < 0.001). Overall, conditions such as urinary tract infections (UTI) - (RR11.43, p < 0.001), septicemia (RR8.53, p < 0.001), pneumonia (RR2.84, p < 0.001), chronic skin ulcers (RR20.64, p < 0.001), and lower limb and femoral neck fractures (RR2.86, p < 0.001) were present with increased frequency among MS patients. Patterns of comorbidity varied markedly by age group. The estimated average annual in-hospital charges adjusted to 2010 dollars for all MS inpatient hospitalizations was 3 billion U.S. dollars.
Patients with MS are admitted into hospital at a younger age, are hospitalized longer and consume more Medicare resources than the similar patients without MS in the general population. Infections account for a large proportion of MS-associated hospitalizations, from young adulthood onward. These findings are particularly significant in light of the increasing availability of disease modifying therapies with more potent immunosuppressive properties, as well as the accumulating data that systemic infection can drive MS relapses.
确定美国多发性硬化症 (MS) 患者住院负担和常见主要入院诊断。
美国 MS 患者的住院负担和导致住院的情况尚未得到充分描述。
使用 2001 年至 2010 年的全国住院患者样本，确定所有主要或次要 MS 诊断的患者，并将主要入院诊断与非 MS 患者进行比较。研究了特定年龄组（1-9 岁、10-19 岁、20-29 岁、30-39 岁、40-49 岁、50-59 岁、60-69 岁、70-79 岁、80-84 岁和≥85 岁）的住院趋势，并获得了人群水平的比率，并与非 MS 患者进行比较，以获得率比 (RR) 和优势比 (OR)。
共确定了 1,240,410 名 MS 患者，占美国每 1000 次住院治疗的 4 例，估计女性/男性比例为 2.72/1。MS 住院患者的中位年龄为 53 岁（四分位距=18）。所有 MS 住院治疗中有 82.17%发生在 30-69 岁年龄组。与非 MS 人群相比，MS 患者的平均住院时间为 5.8 天，而非 4.5 天（p<0.001），并且更多的 MS 患者拥有医疗保险（50.36%比 42.24%，p<0.001）。总体而言，尿路感染 (UTI)（RR11.43，p<0.001）、败血症 (RR8.53，p<0.001)、肺炎 (RR2.84，p<0.001)、慢性皮肤溃疡 (RR20.64，p<0.001) 和下肢和股骨颈骨折 (RR2.86，p<0.001) 等疾病的发生频率在 MS 患者中增加。按年龄组划分，合并症模式差异显著。所有 MS 住院患者调整至 2010 年美元的估计平均年度住院费用为 30 亿美元。
与普通人群中的非 MS 患者相比，MS 患者入院年龄更小，住院时间更长，医疗保险资源消耗更多。感染占 MS 相关住院的很大比例，从年轻成年期开始。鉴于越来越多具有更强免疫抑制特性的疾病修正疗法的出现，以及系统感染可导致 MS 复发的累积数据，这些发现尤其重要。
