The Utility of Administrative Data for Surveillance of Comorbidity in Multiple Sclerosis: A Validation Study

Marrie, Ruth Ann; Yu, Bo; Leung, Stella; Elliott, Lawrence; Caetano, Patrícia; Warren, Sharon; Wolfson, Christina; Patten, Scott B.; Svenson, Lawrence W.; Tremlett, Helen; Fisk, John D.; Blanchard, James

doi:10.1159/000343188

Cited by 65 publications

(95 citation statements)

References 68 publications

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“…We limited our selection of physical conditions to those with a validated algorithm that could identify them from administrative data (Marrie et al. 2012, 2013a,b,c). Validated algorithms (Marrie et al.…”

Section: Methodsmentioning

confidence: 99%

Physical comorbidities increase the risk of psychiatric comorbidity in multiple sclerosis

et al. 2016

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BackgroundRisk factors for psychiatric comorbidity in multiple sclerosis (MS) are poorly understood.ObjectiveWe evaluated the association between physical comorbidity and incident depression, anxiety disorder, and bipolar disorder in a MS population relative to a matched general population cohort.MethodsUsing population‐based administrative data from Alberta, Canada we identified 9624 persons with MS, and 41,194 matches. Using validated case definitions, we estimated the incidence of depression, anxiety disorder, and bipolar disorder, and their association with physical comorbidities using Cox regression, adjusting for age, sex, socioeconomic status, and index year.ResultsIn both populations, men had a lower risk of depression and anxiety disorders than women, as did individuals who were ≥45 years versus <45 years at the index date. The risk of bipolar disorder declined with increasing age. The risks of incident depression (HR 1.92; 1.82–2.04), anxiety disorders (HR 1.52; 1.42–1.63), and bipolar disorder (HR 2.67; 2.29–3.11) were higher in the MS population than the matched population. These associations persisted essentially unchanged after adjustment for covariates including physical comorbidities. Multiple physical comorbidities were associated with psychiatric disorders in both populations.ConclusionPersons with MS are at increased risk of psychiatric comorbidity generally, and some physical comorbidities are associated with additional risk.

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Section: Methodsmentioning

confidence: 99%

Physical comorbidities increase the risk of psychiatric comorbidity in multiple sclerosis

et al. 2016

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“…We selected comorbidities for study based on our prior work indicating they were associated with other outcomes in MS or affected at least 5% of the MS population, 3,4,20 or were important causes of hospitalization in the general population, 21 and could be accurately identified using administrative case definitions. [22][23][24][25][26] The comorbidities included hypertension, diabetes, hyperlipidemia, ischemic heart disease, chronic lung disease, fibromyalgia, autoimmune thyroid disease, migraine, depression, anxiety, and bipolar disorder. We applied validated administrative case definitions based on hospital, physician, and prescription claims for these comorbidities to the MS and matched populations.…”

Section: Standard Protocol Approvals Registrations and Patient Consmentioning

confidence: 99%

“…We applied validated administrative case definitions based on hospital, physician, and prescription claims for these comorbidities to the MS and matched populations. [22][23][24][25][26] Analysis. To identify possible excess hospital utilization in the MS population, we compared all-cause hospitalization rates between the MS and matched populations without adjusting for comorbidities using Poisson regression with generalized estimating equations with an exchangeable correlation to account for repeated hospitalizations by individuals.…”

Section: Standard Protocol Approvals Registrations and Patient Consmentioning

confidence: 99%

Comorbidity increases the risk of hospitalizations in multiple sclerosis

et al. 2015

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Objective: We aimed to evaluate the association between comorbidity and rates of hospitalization in the multiple sclerosis (MS) population as compared to a matched cohort from the general population.Methods: Using population-based administrative data from the Canadian province of Manitoba, we identified 4,875 persons with MS and a matched general population cohort of 24,533 persons. We identified all acute care hospitalizations in the period 2007-2011. Using general linear models, we evaluated the association between comorbidity status and hospitalization rates (all-cause, non-MS-related, MS-related) in the 2 populations, adjusting for age, sex, and socioeconomic status.Results: Comorbidity was common in both cohorts. Over the 5-year study period, the MS population had a 1.5-fold higher hospitalization rate (adjusted rate ratio [aRR] 1.56; 95% confidence interval [CI] 1.44-1.68) than the matched population. Any comorbidity was associated with a 2-fold increased risk of non-MS-related hospitalization rates (aRR 2.21; 95% CI 1.73-2.82) in the MS population, but a nearly 4-fold increase in hospitalization rates in the matched population (aRR 3.85; 95% CI 3.40-4.35). Comorbidity was not associated with rates of hospitalization for MS-related reasons, regardless of how comorbidity status was defined. Conclusions:In the MS population, comorbidity is associated with an increased risk of all-cause hospitalizations, suggesting that the prevention and management of comorbidity may reduce hospitalizations. Neurology ® 2015;84:350-358 GLOSSARY aRR 5 adjusted rate ratio; CI 5 confidence interval; ICD-9 5 International Classification of Diseases-9; MS 5 multiple sclerosis; PHIN 5 personal health identification number; RR 5 rate ratio; SES 5 socioeconomic status.Comorbidity is common in the multiple sclerosis (MS) population. Physical comorbidities, such as hypertension, affect more than one-third of persons with MS.1 Psychiatric comorbidities, such as depression, affect more than 50% of persons with MS over their lifetime.2 Comorbidity is associated with longer diagnostic delays and greater disability at diagnosis and lower quality of life in MS. 3,4 The impact of comorbidity on health care utilization in MS is unknown, but is identified as a key knowledge gap for clinicians and decision-makers.5 Health care utilization is high in the MS population, 6 with up to 25.8% of the MS population being hospitalized annually, 7 exceeding the rate of hospitalizations in the general population. 8 The mean number of physician visits per year is also higher in the MS population.9 In other diseases, persons with multiple chronic health conditions have higher rates of health care utilization than persons with a single condition. 10Hospitalizations constitute the largest component of resource use in Canada and other industrialized countries, 11 and costs of hospitalizations for MS are rising. 12 In other chronic diseases, comorbidity is often undertreated, 13 potentially leading to increased hospitalizations. Therefore, we aimed to e...

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“…4 Second, the diagnostic reliability of our ICD-9 algorithms may differ between the VA and HRS-Medicare settings. 32,33 Reassuringly, the primary limitation of these definitions is imperfect sensitivity as opposed to limited specificity. 33 As VA coding practices also tend toward lower sensitivity, 17 this means it is possible that we have understated the difference in neuroimaging utilization between VA and Medicare settings.…”

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confidence: 99%

Neuroimaging overuse is more common in Medicare compared with the VA

et al. 2016

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Objective: To inform initiatives to reduce overuse, we compared neuroimaging appropriateness in a large Medicare cohort with a Department of Veterans Affairs (VA) cohort.Methods: Separate retrospective cohorts were established in Medicare and in VA for headache and neuropathy from 2004 to 2011. The Medicare cohorts included all patients enrolled in the Health and Retirement Study (HRS) with linked Medicare claims (HRS-Medicare; n 5 1,244 for headache and 998 for neuropathy). The VA cohorts included all patients receiving services in the VA (n 5 93,755 for headache and 183,642 for neuropathy). Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or a primary headache. Neuroimaging use was measured with Current Procedural Terminology codes and potential overuse was defined using published criteria for use with administrative data. Increasingly specific appropriateness criteria excluded nontarget conditions for which neuroimaging may be appropriate.Results: For both peripheral neuropathy and headache, potentially inappropriate imaging was more common in HRS-Medicare compared with the VA. Forty-nine percentage of all headache patients received neuroimaging in HRS-Medicare compared with 22.1% in the VA (p , 0.001) and differences persist when analyzing more specific definitions of overuse. A total of 23.7% of all HRS-Medicare incident neuropathy patients received neuroimaging compared with 9.0% in the VA (p , 0.001), and the difference persisted after excluding nontarget conditions. Conclusions:Overuse of neuroimaging is likely less common in the VA than in a Medicare population.Better understanding the reasons for the more selective use of neuroimaging in the VA could help inform future initiatives to reduce overuse of diagnostic testing. Neurology ® 2016;87:792-798 GLOSSARY HRS 5 Health and Retirement Study; ICD-9 5 International Classification of Diseases-9; NCS 5 nerve conduction studies; SPEP 5 serum protein electrophoresis; VA 5 Veterans Affairs.

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The Utility of Administrative Data for Surveillance of Comorbidity in Multiple Sclerosis: A Validation Study

Cited by 65 publications

References 68 publications

Physical comorbidities increase the risk of psychiatric comorbidity in multiple sclerosis

Physical comorbidities increase the risk of psychiatric comorbidity in multiple sclerosis

Comorbidity increases the risk of hospitalizations in multiple sclerosis

Neuroimaging overuse is more common in Medicare compared with the VA

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