ArticleAnnals of clinical and translational neurology2025
Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex.
Article in Annals of clinical and translational neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Genetic Risk in Multiple Sclerosis: Susceptibility, Modifiers and Unresolved Questions.Neurology and therapy · 2026Review
- A susceptibility network analysis of disease trajectories leading to multiple sclerosis: A nationwide cohort study.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Article
- Comorbidities and lifestyle changes as predictors of the multiple sclerosis prodrome: A prospective cohort study.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Article
- Sex-related and age-related differences in healthcare use before multiple sclerosis symptom onset: a matched cohort study.Journal of neurology, neurosurgery, and psychiatry · 2026Article
- Toward a global research agenda for preventing multiple sclerosis.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Article
- Prodromal phase of multiple sclerosis: evidence from sickness absence patterns before disease onset - a matched cohort study.Journal of neurology, neurosurgery, and psychiatry · 2025Article
- Phenotyping Healthcare Use 2-3 Decades Before the First Multiple Sclerosis Demyelinating Event.Annals of clinical and translational neurology · 2025Article
- Health Care Use Before Multiple Sclerosis Symptom Onset.JAMA network open · 2025Article
- Data resource profile: PharmaNet, the database for prescription drug dispensing in British Columbia, Canada.International journal of population data science · 2023Article
- Multiple sclerosis as a biological and clinical continuum: from risk factors to the early stages of disease.Frontiers in neurologyReview
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11 authors.
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Abstract
objectiveElevated healthcare use before multiple sclerosis (MS) onset suggests earlier opportunity to identify MS. Yet their timing and sociodemographic effects are unclear. We examined rates of healthcare use (and by age/sex) for >two decades pre-MS onset.
methodsWe identified people with MS (PwMS) using administrative data from Canada (Ontario) and Sweden (1991-2020) ("administrative" cohort), and the Swedish MS Registry ("clinical" cohort). The first MS/demyelinating diagnostic code (administrative) or symptom onset (clinical) defined MS onset. We compared annual rates of healthcare use (hospital, physician, and emergency-room [ED]) pre-onset between PwMS and up to five matched population controls using negative binomial regression, and by age/sex.
resultsThe administrative cohort = 35,018/136,007 PwMS/controls (Ontario), and 10,269/51,297 (Sweden). Rates of healthcare use were higher for PwMS than controls up to 28 (of 29) years (Ontario) and up to 15 (of 19) years (Sweden) pre-onset. Annual healthcare use rose steadily as onset approached, particularly escalating 7 years pre-onset in Ontario (e.g., hospital visit rate ratios [RRs] exceeded 1.30), and 6 years in Sweden (physician visit RRs > 1.10). RRs peaked the year pre-onset (ED visits [Ontario] = 3.04; 95% CI: 2.94-3.13, physician visits [Sweden] = 2.51; 95% CI: 2.44-2.59). In the year pre-onset, RRs were disproportionately higher for males (ED RRs [Ontario] = 3.30; 95% CI: 3.13-3.48 vs. females = 2.90; 95% CI: 2.79-3.02), and dropped steadily by age (physician visit RRs [Sweden] = 2.61/2.27/1.97/1.72 for 50/40/30/20-year-olds). The smaller clinical cohort (7604/37,974 PwMS/controls) exhibited similar patterns, albeit more modest, with RRs elevated up to 5 years pre-onset (physician visit RR [year-5] = 1.08; 95% CI: 1.02-1.14; RR [year-1] = 1.39;1.33-1.46).
interpretationHigher healthcare use was evident decades before MS onset, escalating 6-7 years pre-onset, peaking the year before, being disproportionately higher for males and older PwMS.
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