Health Care Use Before Multiple Sclerosis Symptom Onset.

Area of Science:

• Neurology
• Epidemiology
• Health Services Research

Background:

• Health care utilization often precedes the diagnosis of multiple sclerosis (MS).
• Previous research primarily focused on the 5-10 years before diagnosis using administrative data.
• Limited studies have explored health care patterns preceding clinically determined MS onset from clinical records.

Purpose of the Study:

• To investigate health care utilization patterns up to 25 years prior to the onset of multiple sclerosis (MS) symptoms.
• To analyze physician visit rates and types in a clinical MS cohort compared to a matched general population.

Main Methods:

• A matched cohort study utilizing prospectively collected clinical and administrative data from British Columbia, Canada.
• Inclusion of 2038 patients with MS and 10,182 matched controls from January 1991 to September 2018.
• Analysis of physician visit rates using adjusted negative binomial models, examining 25 years before MS onset and specific ICD-9 chapters/specialties 15 years before onset.

Main Results:

• Physician visit rates for MS patients were elevated from 14 years before onset, peaking the year before diagnosis.
• Ill-defined symptoms and signs showed elevated rates 15 years prior to onset.
• Mental health-related visits were significant from 14 years before onset, with notable increases in the 3 years preceding MS diagnosis.
• Neurology and ophthalmology visits peaked significantly in the year before MS onset.

Conclusions:

• Increased health care use among MS patients up to 15 years before symptom onset suggests a potentially earlier disease process.
• Vague symptoms, mental health issues, and psychiatric visits may represent early indicators of the prodromal phase of MS.
• Findings highlight the potential for earlier identification and intervention by recognizing pre-diagnostic health care patterns.