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Phenotyping healthcare use before pediatric-onset multiple sclerosis, including by sex and age: A matched cohort

Farahnaz Amini1, Karl Everett2, Feng Zhu1

  • 1Faculty of Medicine (Neurology), The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|May 23, 2026
PubMed

Insights

Healthcare utilization before pediatric-onset multiple sclerosis (POMS) diagnosis shows significant differences. This study reveals prolonged, organ-specific healthcare use and distinct sex and age patterns preceding POMS onset.

Area of Science:

  • Neurology
  • Pediatric Health
  • Epidemiology

Background:

  • The prodromal phase of pediatric-onset multiple sclerosis (POMS) is poorly understood, particularly regarding age and sex variations.
  • Identifying pre-symptomatic patterns can aid in early diagnosis and understanding disease heterogeneity.

Purpose of the Study:

  • To investigate and compare annual hospitalization and physician visit rates in children up to 18 years before their first demyelinating event (pre-index).
  • To examine sex and age group (<12, 12-15, 16 to <18 years) differences in healthcare utilization preceding POMS.

Main Methods:

  • Utilized Ontario administrative data from 1991-2020 for 451 POMS cases and 1420 matched controls.
  • Employed over-dispersed-Poisson models to estimate rate ratios (RRs) for hospitalizations and physician visits, stratified by diagnosis, sex, and age group.

Main Results:

  • Elevated hospitalization rates (ill-defined, other-health-contact, mental, respiratory) were observed by year -1 pre-index (RRs ≥ 3.6).
  • Physician visits for respiratory, endocrine, injury, ill-defined, nervous system, and mental health conditions increased significantly years prior to POMS onset (as early as year -14).
  • Nervous system visits exhibited the largest sex disparity, with significantly elevated rates in males from year -12 and females from year -6, peaking pre-index.
  • Adolescents aged 12-15 years showed sustained elevated rates for respiratory, injury, and ill-defined visits.

Conclusions:

  • Healthcare utilization patterns before POMS onset are prolonged and organ-specific.
  • Observed sex and age differences suggest heterogeneity in the pre-onset disease phase of POMS.
Abstract

Keywords:
Demyelinating diseasehealthcare utilizationhospitalizationspediatric-onset multiple sclerosisphysician visitsprodromesex

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