Health-care use before a first demyelinating event suggestive of a multiple sclerosis prodrome: a matched cohort study
Health-care use before a first demyelinating event suggestive of a multiple sclerosis prodrome: a matched cohort study
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DOI：
10.1016/s1474-4422(17)30076-5
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发表时间：
2017-06-01
期刊：
影响因子：
48
通讯作者：
Tremlett, Helen
中科院分区：
文献类型：
--
作者：
Wijnands, Jose M. A.;Kingwell, Elaine;Tremlett, Helen
背景神经退行性疾病的退变过程可在临床表现前数年开始。我们的目的是通过在第一次脱髓鞘事件之前检查医疗保健的使用模式来确定多发性硬化症的前驱症状是否存在。方法在这项匹配的队列研究中，我们使用来自加拿大四个省(不列颠哥伦比亚省、萨斯喀彻温省、马尼托巴省和新斯科舍省)的相关卫生行政和临床数据库的数据来比较多发性硬化症患者和匹配的普通人群在第一次脱髓鞘疾病声称(健康管理指数日期)或临床报告症状出现(临床指数日期)之前5年的医院、医生和处方使用数据。使用负二项回归估计比率(RR)，并使用随机效应模型进行跨省合并。主要结果是在健康管理或临床指数日期之前的5年中，每年都有全因医疗服务的使用。发现健康管理队列包括14428例多发性硬化症患者和72059名匹配的对照组，他们的数据可从1984年4月到2014年4月。与对照组相比，多发性硬化症患者在首次声称患有脱髓鞘疾病之前的5年至1年期间，每年的医疗保健使用量稳步增加(住院患者的RR从1.26[95%CI 1.16-1.36]增加到1.78[1.50-2.10]；医生声称的从1.24[1.16-1.32]增加到1.88[1.72-2.07]；处方的评估为药物类别，从1.23[1.06-1.41]增加到1.49[1.41-1.59])。在出现临床症状的队列(3202名多发性硬化症患者和16006名对照组)中，医生的说法和处方也有类似的模式，尽管这5年中每年使用的差异大多没有达到统计学意义。根据卫生管理数据，根据卫生管理数据，多发性硬化症患者在首次脱髓鞘事件前5年比对照组更频繁地使用医疗保健，表明存在可测量的多发性硬化症前驱症状。这些发现具有临床和研究意义，包括建立更早的机会窗口来识别和潜在地治疗多发性硬化症。
Background Degenerative processes in neurodegenerative diseases can start years before clinical manifestation. We aimed to establish whether a multiple sclerosis prodromal period exists by examining patterns of health-care use before a first demyelinating event.Methods In this matched cohort study, we used data from linked health administrative and clinical databases from four Canadian provinces (British Columbia, Saskatchewan, Manitoba, and Nova Scotia) to compare hospital, physician, and prescription use data from people with multiple sclerosis and matched general population controls in the 5 years before the first demyelinating disease claim (health administrative index date) or clinically reported symptom onset (clinical index date). Rate ratios (RRs) were estimated using negative binomial regression and combined across provinces using random effect models. The primary outcome was all-cause use of health care during each of the 5 years before the health administrative or clinical index date.Findings The health administrative cohort included 14 428 multiple sclerosis cases and 72 059 matched controls for whom data were available between April, 1984, and April, 2014. Annual health-care use increased steadily between 5 years and 1 year before the first demyelinating disease claim in people with multiple sclerosis compared with controls (from RR 1.26 [95% CI 1.16-1.36] to 1.78 [1.50-2.10] for hospital admissions; from 1.24 [1.16-1.32] to 1.88 [1.72-2.07] for physician claims; and from 1.23 [1.06-1.41] to 1.49 [1.41-1.59] for prescriptions, assessed as drug classes). Similar patterns for physician claims and prescriptions were observed in the cohort with available clinical symptom onset (3202 individuals with multiple sclerosis and 16 006 controls), although the differences in use in each of the 5 years mostly did not reach statistical significance.Interpretation More frequent use of health care in patients with multiple sclerosis than in controls in the 5 years before a first demyelinating event, according to health administrative data, suggests the existence of a measurable multiple sclerosis prodrome. These findings have clinical and research implications, including the establishment of an earlier window of opportunity to identify and potentially treat multiple sclerosis.