Informative patterns of health care utilization preceding the recognition of adult-onset multiple sclerosis: A...

Early recognition of multiple sclerosis (MS) remains a pivotal challenge. Little is understood about the trajectories of health care use before recognition of adult-onset MS, and the relationship of the trajectories with subsequent disability.

We accessed linked clinical and population-based health administrative data in British Columbia, Canada (1991-2020). Using group-based multi-trajectory models, we described the joint trajectories of physician visits, hospitalizations, and prescription classes filled in the 10 years preceding MS recognition - either the first recorded demyelinating event (administrative index date, n = 6349) or MS symptom onset (clinical index date, n = 725) at age ≥ 18 years. Across the identified trajectories, we compared demographics and encounters potentially related to MS pre-index-date. In the clinical cohort, we assessed the relationship between the trajectories and disability scores using a linear mixed-effects model, adjusting for confounders.

Before the administrative index date, we identified 3 trajectories: low (57 % of cohort), moderate (36 %), and high (6 %) health care use. Before the clinical index date, we also identified low (51 %), moderate (40 %), and high (9 %) trajectories. In both cohorts, individuals in the moderate and high (versus low) trajectories were more likely to be female and older, and have earlier neurologist and ophthalmologist visits, and nervous system diagnoses pre-index-date. The moderate (versus low) trajectory was associated with higher subsequent disability (adjusted beta coefficient=0.31;95 %CI:0.09-0.53).

Earlier detection of MS by general practitioners and prompt MS drug treatment may be possible for patients accessing health care frequently, potentially mitigating disability progression.