MS linked to increased healthcare use decades before diagnosis
Doctor visits peaked year before diagnosis, but rose up to 28 years earlier
People with multiple sclerosis (MS) visited doctors, were admitted to the hospital, and used emergency care more often than other people more than two decades before their diagnosis, a large study finds.
The use of these services peaked in the year before a diagnosis, but visits to a primary care physician were elevated up to 28 years earlier.
“Findings suggest differences between those who develop MS and those who do not early in the disease process,” the study’s researchers wrote in “Phenotyping Healthcare Use 2–3 Decades Before the First Multiple Sclerosis Demyelinating Event,” which was published in the Annals of Clinical and Translational Neurology.
In MS, the immune system mistakenly attacks the protective covering around nerve cells in the brain and spinal cord, causing damage. Its symptoms may be mild at first, but tend to build up over time, leading to increasing disability.
In a study funded by the National MS Society and MS Canada, researchers in Canada reviewed how often people with MS used healthcare services — doctor appointments, hospital stays, and emergency room visits — before their diagnosis and compared them with those who never developed MS.
Increasing use of healthcare services
The study used population-based administrative data from 1991 to 2020 from Ontario, Canada’s most populous province, and included data from 35,018 people diagnosed with MS, along with 136,007 age- and sex-matched controls. Both groups had an average of 15 years of health records before their diagnosis.
The patients were an average age of 43 at their disease onset and more than two-thirds (69.2%) were women. Emergency room visit data were available for 19,598 patients and 73,166 controls.
For up to 29 years before their diagnosis, doctor appointments, hospital stays, and emergency room visits for nervous system problems were the highest, peaking the year before a diagnosis when patients had 12 to 17 times higher rates than the controls. Visits for mental health problems and unclear symptoms were also high for nearly 30 years.
The use of healthcare services for other health concerns, such as digestive, breathing, and movement problems, also steadily increased as their diagnosis drew nearer. Visits related to infections, which are considered a risk factor for MS, were also frequent for more than 20 years, peaking just before a diagnosis.
People with MS also had higher visit rates than others across many specialties for up to 28 years before a diagnosis. Visits to internal medicine doctors gradually increased about 25 years before a diagnosis, while visits to mental health and neurology specialists were more than 1.5 times higher starting about 24 years before a diagnosis, peaking in the year before it.
Men with MS showed higher visit rates than women in many areas, including nervous system, mental health, and unclear symptoms. Men also visited neurologists, neurosurgeons, physiatrists, and primary care more often than women. Women had more urology visits, however.
Specific health problems that led to doctor appointments included migraines, which increased 20 years before a diagnosis. Anxiety was the most common mental health problem, increasing over 30 years before a diagnosis. Digestive problems such as nausea, vomiting, and diarrhea were common up to 25 years before a diagnosis, and increased as it drew nearer.
“We found a sustained excess of healthcare use evident across a diversity of conditions and physician specialties. These included higher hospital, physician, and [emergency department] visits,” the researchers wrote. “Understanding patterns across different healthcare types, including [emergency department] visits, before MS onset could enhance the ability to identify high-risk patients earlier.”
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