在首次脱髓鞘事件发生前二十年，医疗保健利用率就有所提高，且因年龄和性别而异。

Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex.

作者信息

Tremlett Helen, Zhu Feng, Everett Karl, Asaf Ayesha, Manouchehrinia Ali, Li Ping, McKay Kyla A, Hillert Jan, Zhao Yinshan, Maxwell Colleen, Marrie Ruth Ann

机构信息

Faculty of Medicine (Neurology), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.

ICES, Toronto, Ontario, Canada.

出版信息

Ann Clin Transl Neurol. 2025 Feb;12(2):415-432. doi: 10.1002/acn3.52267. Epub 2025 Jan 29.

OBJECTIVE

Elevated healthcare use before multiple sclerosis (MS) onset suggests earlier opportunity to identify MS. Yet their timing and sociodemographic effects are unclear. We examined rates of healthcare use (and by age/sex) for >two decades pre-MS onset.

METHODS

We identified people with MS (PwMS) using administrative data from Canada (Ontario) and Sweden (1991-2020) ("administrative" cohort), and the Swedish MS Registry ("clinical" cohort). The first MS/demyelinating diagnostic code (administrative) or symptom onset (clinical) defined MS onset. We compared annual rates of healthcare use (hospital, physician, and emergency-room [ED]) pre-onset between PwMS and up to five matched population controls using negative binomial regression, and by age/sex.

RESULTS

The administrative cohort = 35,018/136,007 PwMS/controls (Ontario), and 10,269/51,297 (Sweden). Rates of healthcare use were higher for PwMS than controls up to 28 (of 29) years (Ontario) and up to 15 (of 19) years (Sweden) pre-onset. Annual healthcare use rose steadily as onset approached, particularly escalating 7 years pre-onset in Ontario (e.g., hospital visit rate ratios [RRs] exceeded 1.30), and 6 years in Sweden (physician visit RRs > 1.10). RRs peaked the year pre-onset (ED visits [Ontario] = 3.04; 95% CI: 2.94-3.13, physician visits [Sweden] = 2.51; 95% CI: 2.44-2.59). In the year pre-onset, RRs were disproportionately higher for males (ED RRs [Ontario] = 3.30; 95% CI: 3.13-3.48 vs. females = 2.90; 95% CI: 2.79-3.02), and dropped steadily by age (physician visit RRs [Sweden] = 2.61/2.27/1.97/1.72 for 50/40/30/20-year-olds). The smaller clinical cohort (7604/37,974 PwMS/controls) exhibited similar patterns, albeit more modest, with RRs elevated up to 5 years pre-onset (physician visit RR [year-5] = 1.08; 95% CI: 1.02-1.14; RR [year-1] = 1.39;1.33-1.46).

INTERPRETATION

Higher healthcare use was evident decades before MS onset, escalating 6-7 years pre-onset, peaking the year before, being disproportionately higher for males and older PwMS.

目的

在多发性硬化症（MS）发病前医疗保健利用率升高，提示有更早识别MS的机会。然而，其发生时间及社会人口学影响尚不清楚。我们研究了MS发病前二十多年的医疗保健利用率（按年龄/性别）。

方法

我们利用加拿大（安大略省）和瑞典（1991 - 2020年）的行政数据（“行政”队列）以及瑞典MS登记处（“临床”队列）确定MS患者（PwMS）。首个MS/脱髓鞘诊断代码（行政）或症状发作（临床）定义为MS发病。我们使用负二项回归比较了PwMS与多达五名匹配的人群对照在发病前的年度医疗保健利用率（医院、医生和急诊室[ED]），并按年龄/性别进行比较。

结果

行政队列中，安大略省有35,018/136,007名PwMS/对照，瑞典有10,269/51,297名。在发病前长达28年（共29年）（安大略省）和15年（共19年）（瑞典）的时间里，PwMS的医疗保健利用率高于对照。随着发病临近，年度医疗保健利用率稳步上升，在安大略省发病前7年尤其急剧上升（例如，医院就诊率比[RRs]超过1.30），在瑞典发病前6年（医生就诊RRs > 1.10）。RRs在发病前一年达到峰值（安大略省急诊就诊[RRs] = 3.04；95%可信区间：2.94 - 3.13，瑞典医生就诊[RRs] = 2.51；95%可信区间：2.44 - 2.59）。在发病前一年，男性的RRs不成比例地更高（安大略省急诊RRs[男性] = 3.30；95%可信区间：3.13 - 3.48，女性 = 2.90；95%可信区间：2.79 - 3.02），且随年龄稳步下降（瑞典医生就诊RRs[50/40/30/20岁] = 2.61/2.27/1.97/1.72）。规模较小的临床队列（7604/37,974名PwMS/对照）呈现出类似模式，尽管程度较轻，发病前5年RRs升高（医生就诊RR[第5年] = 1.08；95%可信区间：1.02 - 1.14；RR[第1年] = 1.39；1.33 - 1.46）。