Canadian Study Reports Fewer MS-related Hospital Admissions as Patients Age and Among Women

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by Ana Pena PhD |

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Older age, a greater number of health conditions, and prior hospital admissions are associated with more hospitalizations due to all causes among people with multiple sclerosis (MS). However, MS-related hospitalizations decrease as patients age, and are less frequent among women, according to a study analyzing more than two decades of hospitalizations in Saskatchewan, Canada.

Reasons for hospital admissions can differ by age, and clinicians should consider this factor when managing MS patients to prevent hospitalizations, researchers suggest.

The study, “Predictors of Hospitalization in a Canadian MS Population: a Matched Cohort Study,” was published in the journal Multiple Sclerosis and Related Disorders.

“The long-term and potentially disabling nature of MS is not only a burden to affected individuals and their families, but also has a significant impact on the healthcare system,” in which hospitalizations are the most costly component, the researchers noted.

While the rates of hospitalization in both MS patients and the general population have decreased over the last two decades, hospitalization rates among patients remain high in Canada.

Previous studies have examined some predictors of hospitalization (e.g. age, income, type of MS, disease duration) among MS patients in the country, but results differed, likely due to the different study designs, data sources, and study populations.

As MS treatment practices (e.g. choice of initial therapy, access to care) differ between Canadian provinces, evaluating predictors in various regions can provide additional insights to prevent future hospitalizations, and inform healthcare decisions.

Thus, the researchers examined hospitalization rates and factors that could predict the frequency of hospital admissions of MS patients in the Canadian province of Saskatchewan, which has one of the highest rates of overall hospital admissions in the country. Until 2016 (the end of the study), the province did not have a neurologist specialized in MS care.

Looking at population-based health data from Saskatchewan, collected from 1996–2016, the researchers identified 4,878 MS patients (11,744 hospitalizations) who were followed for an average of 11.7 years, and 23,662 sex- and age-matched control subjects (32,541 hospitalizations) who were followed for an average of 11.5 years.

Mathematical models were used to analyze the rate of hospitalization and reason for admission for each study individual, and to test the following potential predictors of hospitalization: sex, age, median household income, calendar year, prior hospitalizations, and comorbidity status.

Results showed that MS patients had a higher rate of hospital admissions and longer hospital stays than the general population, although the numbers decreased over time. Hospital admissions for MS patients decreased from 25.9 per 100 persons in 1997, to 15.3 per 100 persons in 2016. Over the study period, 65.5% of MS patients were hospitalized at least once compared to 43.6% of their counterparts without the disease. MS patients also stayed longer in hospital — a mean average of 11.2 days versus 8.6 days for the general population.

A higher comorbidity burden (a greater number of other health conditions), older age, and prior hospital admissions were associated with an increased rate of hospitalizations for all causes, for people with MS and those without the disease. In contrast, MS-related hospitalizations decreased with age, and there were no associations with comorbidity or prior hospital admissions.

“Assuming that many of the MS-related hospitalizations are due to relapses, these findings are not surprising, given that the natural history studies of MS have shown that disease activity decreases with age,” the researchers noted.

Sex also had a significant effect but only on the MS population. Males were more likely to be hospitalized than females, both for all-cause and MS-specific hospitalizations.

As subjects aged, the gap in the frequency of hospitalizations between MS patients and the general population narrowed.

“This is likely due to a combination of decreased disease activity, change in MS disease management over the last several years, and increasing illness in the general population with age,” the researchers said.

Moreover, people diagnosed with MS were significantly less likely to be hospitalized due to neoplasms (abnormal growth of cells that may be benign or malignant), diseases of the circulatory system, or mental health and behavioral disorders.

Overall, the results “highlight that reasons for hospitalizations can differ by age, and that clinicians should consider this when managing patients to try to reduce hospitalizations in the MS population,” the team said.

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