Common comorbidities and survival in MS: Risk for stroke, type 1 diabetes and infections

Murtonen, Annukka; Kurki, Samu; Hänninen, Katariina; Soilu‐Hänninen, Merja; Sumelahti, Marja‐Liisa

doi:10.1016/j.msard.2017.10.019

Cited by 27 publications

(29 citation statements)

References 34 publications

(30 reference statements)

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“…These results confirm the survival disadvantage reported for cerebrovascular diseases among MS patients in a Danish study (85). Additionally, a recently published large study from Finland showed that the mean survival time is lower for MS patients with any circulatory disease (86). Among the NARCOMS registry participants, vascular, mental, and visual comorbidities increased the risk of mortality (87).…”

Section: Effect Of Comorbidities On Mortalitysupporting

confidence: 80%

Comorbidity in Multiple Sclerosis

2020

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Comorbidities in patients with multiple sclerosis (MS) has become an area of increasing interest in the recent years. A comorbidity is defined as any additional disease that coexists in an individual with a given index disease and that is not an obvious complication of the index disease. The aim of this review is to describe the current evidence regarding the range of comorbidities in the population with MS reported in different countries and the current knowledge about the influence of comorbidities on the clinical features and therapeutic challenges in MS. Certain comorbidities are more prevalent in people with MS such as depression, anxiety, cerebro-and cardiovascular diseases, and certain autoimmune disorders such as diabetes, thyroid disease, and inflammatory bowel disease. A previous perception of a trend toward a lower overall risk of cancer in patients with MS appears to be challenged, but there is no evidence on any higher occurrence of malignancies in the population with MS. Comorbidities may modify the clinical presentation of MS, and have implications for treatment choice, adherence, and outcome. Several comorbid conditions are associated with increased disability progression, including diabetes, hypertension, and chronic obstructive pulmonary disease. Comorbidities are common in MS from the time of diagnosis and may account for some of the heterogeneity observed in MS, including diagnostic delay, clinical presentation, degree of disability progression, rate of health care utilization, working ability, employment status, and quality of life. Coexisting diseases and polypharmacy increase the complexity of patient management and poses major challenges, particularly with the increasing number of immunosuppressive disease-modifying therapies.

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Section: Effect Of Comorbidities On Mortalitysupporting

confidence: 80%

Comorbidity in Multiple Sclerosis

2020

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“…Recent studies suggest an increased risk of cardiovascular events in patients with MS. 7 , 18 – 24 Although the literature is still incomplete and partially contradictory, some larger population-based studies suggest that MS patients have a higher prevalence of cardiovascular diseases (CVD) and a slightly increased CVD mortality risk. 18 , 19 , 22 , 25 In addition, a recent Swedish cohort study found that venous thromboembolic disorders in progressive MS accounted for a substantial proportion of this risk.…”

Section: Introductionmentioning

confidence: 99%

“…2 Physical and mental comorbidities represent significant concerns in MS, since they negatively impact quality of life and clinical outcomes in patients and may contribute to increased adverse risks in patients receiving disease modulatory therapies (DMTs). 3 Compared to the general population, a higher proportion of MS patients are diagnosed with physical conditions such as inflammatory bowel disease, acute infections, malignancies, diabetes, fractures, and hyperlipidemia, [3][4][5][6][7][8][9][10][11][12] as well as mental disorders such as depression, bipolar disorders, and anxiety. 3,[13][14][15][16][17] contradictory, some larger population-based studies suggest that MS patients have a higher prevalence of cardiovascular diseases (CVD) and a slightly increased CVD mortality risk.…”

Section: Introductionmentioning

confidence: 99%

Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden

Castelo-Branco¹,

Chiesa²,

Bengtsson³

et al. 2020

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Background Comorbidity is of significant concern in multiple sclerosis (MS). Few population-based studies have reported conditions occurring in MS after diagnosis, especially in contemporary cohorts. Objective To explore incident comorbidity, mortality and hospitalizations in MS, stratified by age and sex. Methods In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years) and 61,828 matched MS-free individuals were identified between 1 January 2008 and 31 December 2016, using national registers. Incidence rates (IRs) and incidence rate ratios (IRRs) with 95% CI were calculated for each outcome. Results IRs of cardiovascular disease (CVD) were higher among MS patients than MS-free individuals, (major adverse CVD: IRR 1.42; 95% CI 1.12–1.82; hemorrhagic/ischemic stroke: 1.46; 1.05–2.02; transient ischemic attack: 1.65; 1.09–2.50; heart failure: 1.55; 1.15–2.10); venous thromboembolism: 1.42; 1.14–1.77). MS patients also had higher risks of several non-CVDs such as autoimmune conditions (IRR 3.83; 3.01–4.87), bowel dysfunction (2.16; 1.86–2.50), depression (2.38; 2.11–2.68), and fractures (1.32; 1.19–1.47), as well as being hospitalized and to suffer from CVD-related deaths ((1.91; 1.00–3.65), particularly in females (3.57; 1.58–8.06)). Conclusion MS-patients experience a notable comorbidity burden which emphasizes the need for integrated disease management in order to improve patient care and long-term outcomes of MS.

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“…Multiple sclerosis (MS), a complex and chronic neurological disease, has been associated with coexisting diabetes mellitus (types 1 and 2), hypertension and other cardiometabolic disorders, as well as depression and other mental health disorders. 1–3 Although the causal directions are not clear, evidence is emerging on the key risk and protective factors influencing the burden of MS and its comorbidities, including community characteristics and built environments that favour or hinder physical activity in daily life. 4–6 In Canada, prevalence of MS is high; however, research into factors that may shape provincial differences in MS outcomes is limited.…”

Section: Introductionmentioning

confidence: 99%

Neighbourhood environments and the risk of hospital admission for cardiometabolic and mental health comorbidities in multiple sclerosis: A population cohort analysis using linked administrative data

2019

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This study exploits administrative data for neuroepidemiological research and examines associations between neighbourhood environments and risk of hospitalization among multiple sclerosis (MS) patients in New Brunswick, Canada. We created a provincial database of MS patients by linking administrative health records with geographic-based characteristics of local communities. Using Cox models, we found the risk of admission for cardiometabolic complications was lower among residents of ethnically homogeneous neighbourhoods (hazards ratio [HR]: 0.75 [95% confidence interval (CI): 0.60–0.95]); that for mental health disorders was higher in socioeconomically deprived (HR: 1.80 [95% CI: 1.06–3.05]) and residentially unstable (HR: 1.61 [95% CI: 1.05–2.46]) neighbourhoods. Results suggest that selected neighbourhood environments may be associated with differential hospital burden among MS patients.

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Common comorbidities and survival in MS: Risk for stroke, type 1 diabetes and infections

Cited by 27 publications

References 34 publications

Comorbidity in Multiple Sclerosis

Comorbidity in Multiple Sclerosis

Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden

Neighbourhood environments and the risk of hospital admission for cardiometabolic and mental health comorbidities in multiple sclerosis: A population cohort analysis using linked administrative data

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