Comorbidities, insurance status drive emergency department visits
Visits for MS attacks rare, but patients still seek emergency help
People with multiple sclerosis (MS) are significantly more likely to visit an emergency department if they have other health problems, aren’t on disease-modifying treatments (DMTs), or have public or no insurance, according to a study at Massachusetts General Hospital in Boston.
“Although ED [emergency department] visits for MS attacks are now rare, ED visits overall remain relatively common for people with MS,” the researchers wrote. “Our study provides insights into the reasons and risk factors for ED visits among adults living with MS.”
The study, “Multiple Sclerosis in the Emergency Department: A Retrospective Case-Control Study in a Large US Center,” was published in the journal Neurology Neuroimmunology & Neuroinflammation.
MS is a neurodegenerative disease, but patients are now living longer, partly due to the availability of new, high-efficacy DMTs. These medications help prevent relapses — when MS symptoms suddenly worsen or new symptoms appear — and slow disease progression.
However, patients often have comorbidities, or other health problems. The researchers said patients in the U.S. face a “triple burden” — infections, chronic diseases such as high blood pressure, and injuries — that can lead to emergency department visits.
Study uncovers MS care patterns, risks
“There are evolving patterns of health care utilization among people with MS, including very low numbers of ED visits for MS attacks,” the researchers wrote.
The researchers looked at the medical records of people with MS who visited the Mass General emergency department over about 4.5 years (from June 2019 to December 2023). They expected fewer visits among those on high-efficacy DMTs, as seen in other countries where these treatments are widely used.
Of 900 people diagnosed with MS, 300 had visited the emergency department at least once. The 600 who had not been to the emergency department during the study’s timeframe served as controls. Most patients were female and white.
Patients who visited the emergency department had, on average, more comorbidities than the controls. That’s based on a higher Charlson Comorbidity Index (CCI), which accounts for both the number of other health problems and how severe they are. The patients who sought emergency care scored 0.83 on the index, while those who had not scored 0.05. Most controls (97.3%) had a CCI of zero, indicating no comorbidities.
Just over half of patients (52%) visited the emergency department only once, while about one-quarter (26.6%) had three or more visits. COVID-19 was the top reason leading to emergency care (4.4%), followed by high blood pressure and mental health problems and infections. Two patients sought emergency care due to MS relapses.
Nearly two-thirds of patients (64.3%) who visited the emergency department were not being treated with DMTs. A smaller proportion of patients (24.4%) were being treated with high-efficacy DMTs.
Statistical analysis to identify the factors linked to emergency department visits found that the strongest predictor was a person’s CCI score. A higher score was associated with a 4.23 times greater likelihood of using the emergency department.
This was followed by not being on any DMT, which increased a person’s chances by 2.56 times, and having public or no insurance, which made it twice as likely that patients would visit the emergency department.
“This means that for every 100 patients, those without a DMT were 156% more likely to visit the ED,” the researchers wrote.
Identifying as a racial minority led to a 52% lower likelihood of an emergency department visit.
“Addressing comorbidities, disparities in health care access, and the needs of patients not receiving DMTs are each essential for optimizing care for people with MS,” they concluded. Such strategies could also reduce unnecessary emergency visits.
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