Patterns of Comorbidity and Multimorbidity Among Patients With Multiple Sclerosis in a Large US Commercially Insured and Medicare Advantage Population

Abstract

Background: Comorbidities are common in patients with multiple sclerosis (MS), thus increasing the complexity of disease management and economic burden and worsening their prognosis and quality of life. Real-world evidence comparing comorbidities and multimorbidity patterns of commercially insured vs Medicare enrollees with MS is lacking. Objective: To evaluate the patterns of comorbidity and multimorbidity among patients with MS in a US commercially insured and Medicare Advantage population. Methods: This retrospective observational cohort study was conducted using Aetna health claims data from January 1, 2015, to October 31, 2019. Eligibility criteria were (1) at least 3 MS-related inpatient/outpatient (ICD-10-CM: G35), or disease-modifying therapy claims within 1 year (date of first claim = index date); (2) Aetna commercial health plan or Medicare Advantage medical and pharmacy benefits at least 12 months pre-/post-index; and (3) age 18 and older. Commercially insured patients, Medicare Advantage patients younger than 65 years of age, and Medicare Advantage patients 65 years and older were compared. Results: Among 5000 patients (mean [SD] age, 52.6 [12.9]; 75.2% female), 53% had commercial insurance and 47% had Medicare Advantage (59.2% disabled age <65). Medicare Advantage patients were older (age <65: 53.3 [7.9]; age ≥65: 70.8 [5.2]) vs commercial (age, 45.7 [10.2]), had greater comorbidity burden (Charlson Comorbidity Index; age <65: 1.17 [1.64], age ≥65: 1.65 [1.95]) vs commercial (0.53 [1.02]) (all P < .0001). Symptoms specific to MS (ie, malaise, fatigue, depression, spasms, fibromyalgia, convulsions) were more common among patients younger than 65 (all P < .0001). Age-related and other comorbidities (ie, hypertension, hyperlipidemia, dyspepsia, osteoarthritis, osteoporosis, glaucoma, diabetes, cerebrovascular, cancer) were more common among patients 65 years and older Medicare Advantage (all P < .0001). Multiple comorbidities were highly prevalent (median, 4 comorbidities), particularly among Medicare Advantage patients younger than 65 (median, 6) and Medicare Advantage patients 65 and older (median, 7). Conclusions: Comorbidities and multimorbidity patterns differed between patients with MS with commercial insurance and patients with Medicare Advantage. Multimorbidity was highly prevalent among patients with MS and should be considered in the context of clinical decision making to ensure comprehensive MS management and improve outcomes.

Multimorbidity and Its Associations With Anxiety and Depression Among Newly Diagnosed Patients With Breast Cancer: A Retrospective Observational Cohort Study in a US Commercially Insured and Medicare Advantage Population

“…37 Unlike surveys or registry-based studies, we were able to include a wide spectrum of comorbid conditions, which are available in the healthcare claims databases. 37 To the best of our knowledge, this study is the first largescale, population-based study evaluating the overall burden of comorbidity and multimorbidity and their association with anxiety and depression among newly diagnosed patients with breast cancer in the US. This work highlights the complexity of the growing population of breast cancer survivors; it shows that 27.7% of breast cancer patients experienced anxiety and 21.9% experienced depression during the first year after the breast cancer diagnosis.…”

“…Due to the limited space for survey questionaries or instruments, both health surveys and patient registries can only collect carefully selected data. 37 Unlike surveys or registry-based studies, we were able to include a wide spectrum of comorbid conditions, which are available in the healthcare claims databases. 37 To the best of our knowledge, this study is the first largescale, population-based study evaluating the overall burden of comorbidity and multimorbidity and their association with anxiety and depression among newly diagnosed patients with breast cancer in the US.…”

“…37 Unlike surveys or registry-based studies, we were able to include a wide spectrum of comorbid conditions, which are available in the healthcare claims databases. 37…”

“…Due to the limited space for survey questionaries or instruments, both health surveys and patient registries can only collect carefully selected data. 37 Unlike surveys or registry-based studies, we were able to include a wide spectrum of comorbid conditions, which are available in the healthcare claims databases. 37…”

“…However, this approach is conventionally used in many observational studies. 8,11,32,37,46,55 Second, we have not compared multimorbidity, anxiety and depression before and after breast cancer diagnosis and between breast cancer population and general population in the current study. Multimorbidity, anxiety and depression may pose a risk for new-onset chronic diseases and multimorbidity, 51 which need further studies.…”