Comorbidity delays diagnosis and increases disability at diagnosis in MS
Comorbidity delays diagnosis and increases disability at diagnosis in MS
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DOI：
10.1212/01.wnl.0000333252.78173.5f
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发表时间：
2009-01-13
期刊：
影响因子：
9.9
通讯作者：
Vollmer, T.
中科院分区：
文献类型：
--
作者：
Marrie, R. A.;Horwitz, R.;Vollmer, T.
背景：共病在普通人群中很常见，并与不良的健康结局有关。在多发性硬化症(MS)中，尚不清楚先前存在的共病是否会影响最初症状和诊断之间的延迟(“诊断延迟”)或MS诊断时残疾的严重程度。目的：利用北美多发性硬化症注册研究委员会，我们评估了共病与诊断延迟和诊断时残疾的严重程度之间的关系。2006年，我们询问了参与者的身体和精神合并症，包括诊断日期、吸烟状况、当前身高以及过去和现在的体重。使用多变量COX回归，我们比较了诊断时有和没有共病的参与者之间的诊断延迟。我们使用患者确定的疾病步骤将在诊断后2年内登记的参与者(n=2,375)分为轻度、中度或重度残疾，并使用多分类Logistic回归分析残疾与共病的相关性。结果：研究包括8,983名参与者。在对人口统计学和临床特征进行多变量调整后，如果存在肥胖、吸烟或身体或精神并存，诊断延迟会增加。在诊断后2年内登记的参与者中，血管共病(优势比[OR]1.51，95%可信区间1.12-2.05)或肥胖(优势比1.38，95%可信区间1.02-1.87)的参与者在确诊时中度残疾与轻度残疾的调整后优势增加。肌肉骨骼(OR 1.81，95%CI 1.25~2.63)或精神(OR 1.62，95%CI 1.23~2.14)合并症增加了重度残疾与轻度残疾的几率。这些关联背后的机制值得进一步调查。神经病学(R)2009；72：117-124
Background: Comorbidity is common in the general population and is associated with adverse health outcomes. In multiple sclerosis (MS), it is unknown whether preexisting comorbidity affects the delay between initial symptom onset and diagnosis ("diagnostic delay") or the severity of disability at MS diagnosis.Objectives: Using the North American Research Committee on Multiple Sclerosis Registry, we assessed the association between comorbidity and both the diagnostic delay and severity of disability at diagnosis. In 2006, we queried participants regarding physical and mental comorbidities, including date of diagnosis, smoking status, current height, and past and present weight. Using multivariate Cox regression, we compared the diagnostic delay between participants with and without comorbidity at diagnosis. We classified participants enrolled within 2 years of diagnosis (n = 2,375) as having mild, moderate, or severe disability using Patient Determined Disease Steps, and assessed the association of disability with comorbidity using polytomous logistic regression.Results: The study included 8,983 participants. After multivariable adjustment for demographic and clinical characteristics, the diagnostic delay increased if obesity, smoking, or physical or mental comorbidities were present. Among participants enrolled within 2 years of diagnosis, the adjusted odds of moderate as compared to mild disability at diagnosis increased in participants with vascular comorbidity (odds ratio [OR] 1.51, 95% CI 1.12-2.05) or obesity (OR 1.38,95% CI 1.02-1.87). The odds of severe as compared with mild disability increased with musculoskeletal (OR 1.81, 95% CI 1.25-2.63) or mental (OR 1.62, 95% CI 1.23-2.14) comorbidity.Conclusions: Both diagnostic delay and disability at diagnosis are influenced by comorbidity. The mechanisms underlying these associations deserve further investigation. Neurology (R) 2009; 72: 117 - 124