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Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality

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  1. Randomized trial of daily high-dose vitamin D3 in patients with RRMS receiving subcutaneous interferon β-1a

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  2. Author response: Nationwide prevalence and incidence study of neuromyelitis optica spectrum disorder in Denmark

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  3. Fat oxidation is impaired during exercise in lipin-1 deficiency

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  4. Declining malformation rates with changed antiepileptic drug prescribing: An observational study

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  5. Neuromuscular adverse events associated with anti-PD-1 monoclonal antibodies: Systematic review

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  1. Klinisk Neurologi og Neurokirurgi

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  2. Author response: Nationwide prevalence and incidence study of neuromyelitis optica spectrum disorder in Denmark

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  3. Alcohol consumption in adolescence is associated with a lower risk of multiple sclerosis in a Danish cohort

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OBJECTIVE: To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS.

METHODS: We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of diagnosis, we compared individuals with and without chronic comorbidity using multinomial logistic regression. To investigate mortality, we used Cox regression with time-dependent covariates, following study participants from clinical MS onset until endpoint (death) or to the end of the study, censuring at emigration.

RESULTS: We identified 8,947 individuals with clinical onset of MS between 1980 and 2005. In the study of time of diagnosis, we found statistically significant odds ratios for longer diagnostic delays with cerebrovascular comorbidity (2.01 [1.44-2.80]; <0.0005), cardiovascular comorbidity (4.04 [2.78-5.87]; <0.0005), lung comorbidity (1.93 [1.42-2.62]; <0.0005), diabetes comorbidity (1.78 [1.04-3.06]; 0.035), and cancer comorbidity (2.10 [1.20-3.67]; 0.009). In the mortality study, we found higher hazard ratios with psychiatric comorbidity (2.42 [1.67-3.01]; <0.0005), cerebrovascular comorbidity (2.47 [2.05-2.79]; <0.0005), cardiovascular comorbidity (1.68 [1.39-2.03]; <0.0005), lung comorbidity (1.23 [1.01-1.50]; 0.036), diabetes comorbidity (1.39 [1.05-1.85]; 0.021), cancer comorbidity (3.51 [2.94-4.19]; <0.0005), and Parkinson disease comorbidity (2.85 [1.34-6.06]; 0.007).

CONCLUSIONS: An increased awareness of both the necessity of neurologic evaluation of new neurologic symptoms in persons with preexisting chronic disease and of optimum treatment of comorbidity in MS is critical.

Original languageEnglish
JournalNeurology
Volume89
Issue number16
Pages (from-to)1668-1675
Number of pages8
ISSN0028-3878
DOIs
Publication statusPublished - 17 Oct 2017

    Research areas

  • Adult, Autoimmune Diseases, Cardiovascular Diseases, Cerebrovascular Disorders, Cohort Studies, Community Health Planning, Comorbidity, Delayed Diagnosis, Denmark, Female, Humans, Kidney Diseases, Logistic Models, Male, Middle Aged, Mood Disorders, Multiple Sclerosis, Neoplasms, Neurologic Examination, Parkinson Disease, Time Factors, Young Adult, Journal Article

ID: 52217822