Pediatric-onset MS children have higher healthcare needs from birth
Children who developed MS visited physicians earlier in life
Children with pediatric-onset multiple sclerosis (MS) tend to use more healthcare resources than their peers, starting from birth and escalating until the onset of their symptoms, a study reports.
Young people who developed MS visited physicians earlier in life and in the six years before they first had MS symptoms, which could represent a very early disease period, called the prodromal phase, according to the study’s researchers.
“The identification of prodromal disease could lead to earlier intervention and clarify the etiologically relevant period for preventing MS,” they wrote. The study, “Health care use preceding pediatric multiple sclerosis: A population-based study from Ontario, Canada,” was published in Multiple Sclerosis Journal.
MS occurs when the immune system attacks the myelin sheath, a fatty layer that protects nerve cells and enables neural communication. This demyelination process generally affects the neurons that control movement, resulting in difficulty walking and other symptoms. Its underlying causes remain unknown for adults and for pediatric-onset MS, a more rare type of MS.
Understanding prodromal disease states could lead to early interventions and knowing better when to take action to prevent MS, according to the researchers.
In adults with MS, prodromal phase symptoms may include difficulty sleeping and mental health challenges. These tend to set in around five years before being diagnosed, leading to higher healthcare utilization in the year before a diagnosis. However, the prodromal phase and its potential effects on healthcare needs are less well characterized for children with MS.
Earlier healthcare needs with MS
Here, researchers used administrative databases from Ontario to identify 451 people diagnosed with MS before age 18. They matched each person with MS to children with similar demographic characteristics, but without MS, to form a comparative control group.
For the children in the MS group, the first healthcare claim for demyelinating disease occurred at an average age of 14. The researchers referred to the time of this claim as the index date and compared physician visits and hospitalizations with controls for up to 18 years before the index date.
Physician visits were more common for children with MS throughout life. This difference was largest in early life and in the years before a diagnosis. The researchers described the pattern as “a U-shaped curve,” where the biggest differences showed up in the first few years of life, then became smaller, but still noticeable, during early childhood and started growing again steadily in the last six to seven years before a diagnosis.
Similar patterns emerged for hospitalizations, where those with MS had more hospitalizations than the non-MS group, even up to 10 years before a diagnosis. They also had higher hospitalization rates early in life.
Children in the MS group visited specialists at much higher rates than the control group children. Specifically, physician visit rates “were [14 times] higher for neurologists and neurosurgeons, [five times] higher for psychiatrists, and [four times] higher for physiatrists,” the researchers wrote.
In a subgroup who had healthcare data since birth, the researchers examined healthcare utilization by age rather than relative to the index date. In their first year of life, the MS children had about twice the number of physician visits and hospitalizations. These included “visits to internists, neurologists, dermatologists, primary care providers, general pediatricians, and urologists.”
This indicates “the perinatal and early childhood periods may be risk periods for MS,” wrote the researchers, who suggested that investigating these times, as well as the possible prodromal phase in the six years before disease onset, could help scientists better understand how pediatric-onset MS develops.
Healthcare administration data being perhaps not be the most accurate method to pinpoint disease onset and diagnosis was noted as a limitation of the study. The findings also may be specific to the region, which has a publicly administered, provincial health insurance plan, researchers said..
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