Physical and Mental Health Comorbidities Among Adults With Multiple Sclerosis

Mark D Peterson; Paul Lin; Neil Kamdar; Christina N Marsack-Topolewski; Elham Mahmoudi

doi:10.1016/j.mayocpiqo.2021.11.004

Physical and Mental Health Comorbidities Among Adults With Multiple Sclerosis

Mayo Clin Proc Innov Qual Outcomes. 2021 Dec 23;6(1):55-68. doi: 10.1016/j.mayocpiqo.2021.11.004. eCollection 2022 Feb.

Authors

Mark D Peterson^{1

2}, Paul Lin², Neil Kamdar^{2

3

4

5}, Christina N Marsack-Topolewski⁶, Elham Mahmoudi^{2

7}

Affiliations

¹ Department of Physical Medicine and Rehabilitation.
² Institute for Healthcare Policy and Innovation.
³ Department of Obstetrics and Gynecology.
⁴ Department of Emergency Medicine.
⁵ Department of Surgery.
⁶ School of Social Work, Eastern Michigan University, Ypsilanti.
⁷ Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor.

Abstract

Objective: To compare the incidence of and adjusted hazard ratios for common cardiometabolic diseases, musculoskeletal disorders, and psychological morbidities among adults with and without multiple sclerosis (MS).

Patients and methods: Beneficiaries were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for MS (n=9815) from a national private insurance claims database (Clinformatics Data Mart; OptumInsight). Adults without MS were also included (n=1,474,232) as a control group. Incidence estimates of common cardiometabolic diseases, musculoskeletal disorders, and psychological morbidities were compared at 5 years of continuous enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident morbidities.

Results: Adults with MS had a higher incidence of any common cardiometabolic disease (51.6% [2663 of 5164] vs 36.4% [328,690 of 904,227]), musculoskeletal disorder (68.8% [3411 of 4959] vs 47.5% [512,422 of 1,077,737]), and psychological morbidity (49.4% [3305 of 6691] vs 30.8% [380,893 of 1,235,388]) than adults without MS, and differences were clinically meaningful (all P<.001). Fully adjusted survival models revealed that adults with MS had a greater risk for any (hazard ratio [HR], 1.37; 95% CI, 1.32 to 1.43) and all (HR, 1.19 to 1.48) common cardiometabolic diseases, any (HR, 1.59; 95% CI, 1.53 to 1.64) and all (HR, 1.22 to 2.77) musculoskeletal disorders, and any (HR, 1.57; 95% CI, 1.51 to 1.62) and all (HR, 1.20 to 2.51) but one (impulse control disorders) psychological morbidity.

Conclusion: Adults with MS have a significantly higher risk for development of common cardiometabolic diseases, musculoskeletal disorders, and psychological morbidities (all P<.001) than adults without MS. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of chronic physical and mental disease onset/progression in this higher risk population.

Keywords: HR, hazard ratio; MS, multiple sclerosis; SMD, standardized mean difference.