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Do patients' and referral centers' characteristics influence multiple sclerosis phenotypes? Results from the Italian
Roberto Bergamaschi1, Ettore Beghi2, Cristina Bosetti2
1IRCCS Fondazione Mondino, Pavia, Italy.
Background:
Multiple sclerosis (MS) is characterized by phenotypical heterogeneity, partly resulting from demographic and environmental risk factors. Socio-economic factors and the characteristics of local MS facilities might also play a part.
Methods:
This study included patients with a confirmed MS diagnosis enrolled in the Italian MS and Related Disorders Register in 2000-2021. Patients at first visit were classified as having a clinically isolated syndrome (CIS), relapsing-remitting (RR), primary progressive (PP), progressive-relapsing (PR), or secondary progressive MS (SP). Demographic and clinical characteristics were analyzed, with centers' characteristics, geographic macro-areas, and Deprivation Index. We computed the odds ratios (OR) for CIS, PP/PR, and SP phenotypes, compared to the RR, using multivariate, multinomial, mixed effects logistic regression models.
Results:
In all 35,243 patients from 106 centers were included. The OR of presenting more advanced MS phenotypes than the RR phenotype at first visit significantly diminished in relation to calendar period. Females were at a significantly lower risk of a PP/PR or SP phenotype. Older age was associated with CIS, PP/PR, and SP. The risk of a longer interval between disease onset and first visit was lower for the CIS phenotype, but higher for PP/PR and SP. The probability of SP at first visit was greater in the South of Italy.
Discussion:
Differences in the phenotype of MS patients first seen in Italian centers can be only partly explained by differences in the centers' characteristics. The demographic and socio-economic characteristics of MS patients seem to be the main determinants of the phenotypes at first referral.
Insights
Demographic and socio-economic factors, not facility characteristics, primarily determine multiple sclerosis (MS) phenotypes at initial diagnosis. This impacts understanding disease progression and patient stratification for MS care.
Area of Science:
- Neurology
- Clinical Epidemiology
Background:
- Multiple sclerosis (MS) exhibits significant phenotypical heterogeneity.
- Demographic, environmental, and socio-economic factors influence MS presentation.
- Local healthcare facility characteristics may also contribute to observed differences.
Purpose of the Study:
- To investigate the determinants of MS phenotypes at first clinical referral in Italy.
- To analyze the influence of patient demographics, socio-economic status, and healthcare center characteristics on MS disease course at diagnosis.
Main Methods:
- Utilized data from the Italian MS and Related Disorders Register (2000-2021).
- Classified patients into clinically isolated syndrome (CIS), relapsing-remitting (RR), primary progressive (PP), progressive-relapsing (PR), or secondary progressive MS (SP) at first visit.
- Employed multivariate, multinomial, mixed effects logistic regression to analyze odds ratios for different phenotypes, considering patient and center characteristics, geographic area, and deprivation index.
Main Results:
- Included 35,243 patients from 106 centers.
- Advanced MS phenotypes (PP/PR, SP) at first visit were less common over time.
- Female sex and older age were associated with lower odds of advanced phenotypes.
- Higher risk of advanced phenotypes was linked to longer delays between disease onset and first visit.
- The South of Italy showed a higher probability of SP at first visit.
Conclusions:
- Differences in MS phenotypes at first referral are primarily driven by patient demographic and socio-economic characteristics.
- Healthcare center characteristics explain only a minor part of the observed phenotypical heterogeneity.
- Findings highlight the importance of socio-economic determinants in shaping MS presentation and progression.
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