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Published on: December 9, 2015
Comorbid disease drives short-term hospitalization outcomes in patients with multiple sclerosis
Adys Mendizabal1, Dylan P Thibault1, James A Crispo1
1Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Objective:
Readmission is used as a quality indicator and is the primary target outcome for disease-modifying therapy (DMT) for multiple sclerosis (MS). However, data on readmissions for patients with MS are limited.
Methods:
Using the US Nationwide Readmissions Database, we performed a retrospective cohort study of adults hospitalized for MS in 2014. Primary study outcomes were within 30- and 90-day readmissions. Descriptive analyses compared patient, clinical, and hospital variables readmission status. Multivariable logistic regression models estimated the associations between these variables and readmission.
Results:
Of 16,629 individuals meeting the study criteria, most were women (73.7%), aged 35-54 years (48.0%), and Medicare program participants (36.8%). In total, 49.7% of inpatients with MS had 1-2 comorbid medical conditions and 23.7% had 3 or more. Having 3 or more comorbidity conditions associated with increased adjusted odds of the 30-day readmission (adjusted odds ratio [AOR] 1.92, 1.34-2.74). Anemia (AOR 1.62, 1.22-2.14), rheumatoid arthritis/collagen vascular diseases (AOR 2.20, 1.45-3.33), congestive heart failure (AOR 2.43, 1.39-4.24), chronic pulmonary disease (AOR 1.35, 1.02-1.78), diabetes with complications (AOR 2.27, 1.45-3.56), hypertension (AOR 1.25, 1.03-1.53), obesity (AOR 1.35, 1.05-1.73), and renal failure (AOR 1.68, 1.06-2.67) were associated with the 30-day readmission. Medicare insurance and nonroutine discharge were also associated with readmission, whereas patient characteristics (sex, age, and socioeconomic status) were not. The most frequent (26.7%) reason for readmission was multiple sclerosis. Ninety-day analyses produced similar findings.
Conclusions:
Comorbid diseases were associated with the readmission for persons with multiple sclerosis. Evaluations of the real-world effectiveness for DMTs in reducing hospitalizations in patients with MS may need to consider comorbid disease burden and management.
Insights
Multiple sclerosis (MS) patients with multiple comorbid conditions face higher readmission rates. Managing these comorbidities is crucial for improving MS patient outcomes and reducing hospitalizations.
Area of Science:
- Neurology
- Healthcare Quality
Background:
- Readmission rates serve as a key quality indicator, particularly for disease-modifying therapies (DMTs) in multiple sclerosis (MS).
- Limited data currently exists on readmission patterns for patients diagnosed with MS.
Purpose of the Study:
- To investigate the factors associated with hospital readmissions in patients with multiple sclerosis (MS).
- To identify specific patient and clinical variables that predict readmission risk within 30 and 90 days post-discharge for MS patients.
Main Methods:
- A retrospective cohort study utilizing the US Nationwide Readmissions Database (NRD) from 2014.
- Inclusion criteria comprised adult inpatients hospitalized for MS.
- Statistical analyses included descriptive comparisons and multivariable logistic regression to assess predictors of 30- and 90-day readmissions.
Main Results:
- The study analyzed 16,629 hospitalizations for MS. Key patient demographics included a majority of women (73.7%) and individuals aged 35-54 (48.0%).
- A significant association was found between having three or more comorbid conditions and increased odds of 30-day readmission (AOR 1.92).
- Specific comorbidities like anemia, congestive heart failure, diabetes with complications, and rheumatoid arthritis significantly increased readmission risk. Multiple sclerosis itself was the most frequent reason for readmission (26.7%).
Conclusions:
- Comorbid diseases are strongly associated with increased hospital readmission rates among patients with multiple sclerosis (MS).
- Future evaluations of disease-modifying therapies (DMTs) for MS should incorporate the burden of comorbid conditions to accurately assess real-world effectiveness in reducing hospitalizations.
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