Comorbidity, socioeconomic status and multiple sclerosis

Objective Multiple sclerosis (MS) is associated with substantial morbidity. The impact of comorbidity on MS is unknown, but comorbidity may explain some of the unpredictable progression. Comorbidity is common in the general population, and is associated with adverse health outcomes. To begin understanding the impact of comorbidity on MS, we need to know the breadth, type, and frequencies of comorbidities among MS patients. Using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, we aimed to describe comorbidities and their demographic predictors in MS. Methods In October 2006, we queried NARCOMS participants regarding physical comorbidities. Of 16,141 participants meeting the inclusion criteria, 8983 (55.7%) responded. Results Comorbidity was relatively common; if we considered conditions which are very likely to be accurately self-reported, then 3280 (36.7%) reported at least one physical comorbidity. The most frequently reported comorbidities were hypercholesterolemia (37%), hypertension (30%), and arthritis (16%). Associated with the risk of comorbidity were being male [females vs. males, odds ratio (OR) 0.77; 0.69–0.87]; age (age >60 years vs. age ≤44 years, OR 5.91; 4.95–7.06); race (African Americans vs. Whites, OR 1.46; 1.06–2.03); and socioeconomic status (Income <$15,000 vs. Income >$100,000, OR 1.37; 1.10–1.70). Conclusions Comorbidity is common in MS and similarly associated with socioeconomic status.

[1]  E J Orav,et al.  Disease steps in multiple sclerosis: a longitudinal study comparing Disease Steps and EDSS to evaluate disease progression , 1999, Multiple sclerosis.

[2]  R. Schiffer,et al.  Demographic and Disease Characteristics of People With Multiple Sclerosis Living in Urban and Rural Areas , 2006 .

[3]  M. Metzler,et al.  Socioeconomic status in health research: one size does not fit all. , 2005, JAMA.

[4]  J. Baskerville,et al.  The natural history of multiple sclerosis: a geographically based study. 3. Multivariate analysis of predictive factors and models of outcome. , 1991, Brain : a journal of neurology.

[5]  J. O'connell,et al.  The Comorbidity Symptom Scale: A Combined Disease Inventory and Assessment of Symptom Severity , 2000, Journal of the American Geriatrics Society.

[6]  J. Guralnik,et al.  Gradient of disability across the socioeconomic spectrum in the United States. , 2006, The New England journal of medicine.

[7]  T. Riise,et al.  Multiple sclerosis and chronic inflammatory diseases A case‐control study , 1996, Acta neurologica Scandinavica.

[8]  D W Bates,et al.  Can comorbidity be measured by questionnaire rather than medical record review? , 1996, Medical care.

[9]  Donald R. Miller,et al.  Comorbidity Assessments Based on Patient Report: Results From the Veterans Health Study , 2004, The Journal of ambulatory care management.

[10]  M. Liang,et al.  The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. , 2003, Arthritis and rheumatism.

[11]  C. Hoffman,et al.  Persons with chronic conditions. Their prevalence and costs. , 1996, JAMA.

[12]  C. Constantinescu,et al.  A prospective study of conditions associated with multiple sclerosis in a cohort of 658 consecutive outpatients attending a multiple sclerosis clinic , 2004, Multiple sclerosis.

[13]  David W. Hosmer,et al.  Applied Logistic Regression , 1991 .

[14]  Douglas W Mahoney,et al.  Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. , 2004, Journal of clinical epidemiology.

[15]  J. Keyser Autoimmunity in multiple sclerosis , 1988, Neurology.

[16]  S. Reingold,et al.  Prevalence estimates for MS in the United States and evidence of an increasing trend for women , 2002, Neurology.

[17]  R. Marrie,et al.  Validation of the NARCOMS registry: diagnosis , 2007, Multiple sclerosis.

[18]  P. Groenewegen,et al.  Comorbidity was associated with neurologic and psychiatric diseases: a general practice-based controlled study. , 2006, Journal of clinical epidemiology.

[19]  D. Paty,et al.  The natural history of early onset multiple sclerosis: comparison of data from Moscow and Vancouver , 2002, Clinical Neurology and Neurosurgery.

[20]  L. Fried,et al.  Agreement Between Self‐Report of Disease Diagnoses and Medical Record Validation in Disabled Older Women: Factors That Modify Agreement , 2004, Journal of the American Geriatrics Society.

[21]  O. Andersen,et al.  Prognostic factors in a multiple sclerosis incidence cohort with twenty-five years of follow-up. , 1993, Brain : a journal of neurology.

[22]  S. Reingold,et al.  Revised estimate of the prevalence of multiple sclerosis in the united states , 1992, Annals of neurology.

[23]  P. Rochon,et al.  Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability. A prospective comparison of three comorbidity indices. , 1996, Medical care.

[24]  R. Blake,et al.  Patterns of comorbidity in elderly patients with multiple sclerosis. , 1994, Journal of clinical epidemiology.

[25]  Michael K Gould,et al.  Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review. , 2006, Archives of neurology.

[26]  M. Hernán,et al.  Cigarette smoking and the progression of multiple sclerosis. , 2005, Brain : a journal of neurology.

[27]  D A Asch,et al.  Response rates to mail surveys published in medical journals. , 1997, Journal of clinical epidemiology.

[28]  B. Lindegård,et al.  Diseases associated with multiple sclerosis and epilepsy , 1985, Acta neurologica Scandinavica.

[29]  D. Meltzer,et al.  Use of a Self-Report-Generated Charlson Comorbidity Index for Predicting Mortality , 2005, Medical care.

[30]  A. Achiron,et al.  Late‐Onset Multiple Sclerosis , 2001, Journal of the American Geriatrics Society.

[31]  M. White,et al.  Prevalence estimates for MS in the United States and evidence of an increasing trend for women , 2002, Neurology.

[32]  W. L. Benedict,et al.  Multiple Sclerosis , 2007, Journal - Michigan State Medical Society.

[33]  R. Marrie,et al.  Predictors of alternative medicine use by multiple sclerosis patients , 2003, Multiple sclerosis.

[34]  L. Ferrucci,et al.  Functional decline in lower-extremity peripheral arterial disease: associations with comorbidity, gender, and race. , 2005, Journal of vascular surgery.

[35]  R. Marrie,et al.  Does multiple sclerosis–associated disability differ between races? , 2006, Neurology.

[36]  M M Bergmann,et al.  Validity of self-reported diagnoses leading to hospitalization: a comparison of self-reports with hospital records in a prospective study of American adults. , 1998, American journal of epidemiology.

[37]  R. Marrie,et al.  Validity of performance scales for disability assessment in multiple sclerosis , 2007, Multiple sclerosis.

[38]  J E Keil,et al.  Socioeconomic factors and cardiovascular disease: a review of the literature. , 1993, Circulation.

[39]  J G Collins,et al.  Prevalence of selected chronic conditions: United States, 1986-88. , 1993, Vital and health statistics. Series 10, Data from the National Health Survey.