Multiple sclerosis is associated with higher comorbidity and health care resource use: A population‐based, case–control study in a western Mediterranean region

Abstract

Background and purpose: Comorbidities are common in multiple sclerosis (MS), and have been associated with worse outcomes and increased health care resource usage. We studied the frequency of comorbidities and adverse health behaviors (AHBs) in MS patients in the Mediterranean region of Catalonia.Methods: This population-based, case-control study used primary health care information covering 80% of Catalonia's population. Cases were matched by age/sex with randomly chosen controls (ratio = 1:5). Demographic information, comorbidities, AHBs, annual visits, sick leave days, and medication dispensing were studied. The association of comorbidities with MS and the profile of comorbidities according to sex within MS cases were assessed with multivariate logistic regression models, after adjusting for confounding variables. Health care resource usage was analyzed in MS cases compared to controls, and within MS cases in those with compared to those without comorbidities.Results: Five thousand five hundred forty-eight MS cases and 27,710 controls (70% female, mean age = 48.3 years) were included. Stroke (odds ratio [OR] = 1.54, 95% confidence interval [CI] = 1.17-1.99), epilepsy (OR = 2.46, 95% CI = 1.94-3.10), bipolar disorder (OR = 1.67, 95% CI = 1.17-2.36), and depression (OR = 1.83, 95% CI = 1.70-1.98) were more frequent in MS. Cases were more prone to smoking but less to alcohol intake. Among cases, psychiatric comorbidities were more frequent in women, whereas cardiovascular diseases and AHBs were more frequent in men. MS patients, particularly with comorbidities, had higher health care resource usage than controls. Conclusions: Psychiatric comorbidities, stroke, epilepsy, and AHBs are more common in MS patients than in the general population in the western Mediterranean region of Catalonia. The presence of comorbidities increases the health care resource usage in MS patients.

Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy)

“…In our study, we found that the prevalence of stroke is higher in PwMS than in the general population irrespective of sex and age, in line with the literature [ 30 , 31 ]. The risk of developing cerebrovascular disease has been evaluated in PwMS and, although there are discordant findings [ 32 ], it seems that there is an increased risk of stroke especially in the years immediately following the diagnosis of MS [ 33 ].…”

Contact patterns and costs of multiple sclerosis in the Swedish healthcare system—A population‐based quantitative study

“…A frequent problem in previous studies is which costs should be attributed to MS. One important finding is that oncological therapies were among the most expensive drugs, even in this relatively young patient cohort. A recent community‐based study from Spain found an increased risk for stroke, epilepsy, bipolar disorder, and depression among MS patients (Cardenas‐Robledo et al., 2021 ), underlining the need to consider care and costs other than those directly attributed to MS.…”