Contributions
Abstract: P314
Type: Poster
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Little is known about the rates and types of infections that prompt medical care in the multiple sclerosis (MS) population. We examined the infection-related health care utilization and the types of infections encountered in outpatient and inpatient settings in people with and without MS.
Methods: We performed a retrospective cohort study in British Columbia (BC), Canada using population-based health administrative data. People with MS were identified using a validated algorithm and followed from their first demyelinating disease-related claim (index date: 1996-2013) until the earliest of death, emigration from BC, or the study end (December 31st, 2013). Population controls were matched with MS cases by exact year of birth, sex, and postal code at index date. The monthly rate of infection-related physician visits and prescriptions for anti-infectives filled, and the likelihood of hospital admissions for infections, were compared between populations using negative binomial regression and logistic regression. Models were adjusted for sex, age, year of index date, socioeconomic status, use of immunomodulators and immunosuppressive therapies for non-MS indications, and number of comorbid conditions. Differences in association by sex and age were examined by subgroup analyses. To account for disease modifying drug (DMD) use in MS patients, follow-up was censored at DMD initiation in complimentary analyses.
Results: We identified 7,179 persons with MS and 35,837 matched controls (mean age 45.4 years; 73.8% women). During follow-up, people with MS had 41% more infection-related physician visits (adjusted rate ratio [aRR] 1.41; 95%CI 1.36-1.47), filled 57% more prescriptions for anti-infectives (aRR 1.57; 95%CI 1.49-1.65), and were more likely to be hospitalized for infections (adjusted odds ratio [aOR] 2.40; 95%CI 2.17-2.66) than their matched controls. The difference in health care utilization was greater among men than women and increased with age. Censoring at DMD initiation did not change the interpretation of the findings. Among the most common infections, people with MS had significantly more medical encounters for urinary tract infections, pneumonia, intestinal infectious diseases, infections of the skin, and sepsis.
Conclusion: Our findings indicated an increased infection-related health care utilization in both the outpatient and inpatient setting in people with MS. These results have relevance for the care of people with MS.
Disclosure:
J.M.A. Wijnands: Nothing to disclose.
E. Kingwell: Nothing to disclose.
F. Zhu: Nothing to disclose.
Y. Zhao: Dr. Zhao receives research funding from the NMSS, and received funding from the CIHR, the MSSOC, and the Milan & Maureen Ilich Foundation.
J.D. Fisk: Dr. Fisk receives funding from the Canadian Institutes of Health Research (CIHR), MS Society of Canada, National Multiple Sclerosis Society and the Dalhousie Medical Research Foundation; consultation and distribution royalties from MAPI Research Trust, as well as speakers honoraria and travel expenses from EMD Serono (2013, 2014).
C. Evans: Nothing to disclose.
R.A. Marrie: Dr. Marrie has funding from the Canadian Institutes of Health Research, Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, Rx & D Health Research Foundation, Research Manitoba and sanofi-aventis (clinical trial).
H. Tremlett: Dr. Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis. She has received research support from: the Multiple Sclerosis Society of Canada, the Michael Smith Foundation, for Health Research Scholar, the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, and the UK MS Trust; speaker honoraria and/or travel expenses to attend conferences, from the Consortium of MS Centres (2013), the National MS Society (2012, 2014), Bayer Pharmaceuticals (2010), Teva Pharmaceuticals (2011), ECTRIMS (2011, 2012, 2013, 2014, 2015), UK MS Trust (2011), the Chesapeake Health Education Program, US Veterans Affairs (2012), Novartis Canada (2012), Biogen Idec (2014), American Academy of Neurology (2013, 2014, 2015). Speaker honoraria are either, declined or donated to an MS charity or used as an unrestricted grant by her research group.
Abstract: P314
Type: Poster
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Little is known about the rates and types of infections that prompt medical care in the multiple sclerosis (MS) population. We examined the infection-related health care utilization and the types of infections encountered in outpatient and inpatient settings in people with and without MS.
Methods: We performed a retrospective cohort study in British Columbia (BC), Canada using population-based health administrative data. People with MS were identified using a validated algorithm and followed from their first demyelinating disease-related claim (index date: 1996-2013) until the earliest of death, emigration from BC, or the study end (December 31st, 2013). Population controls were matched with MS cases by exact year of birth, sex, and postal code at index date. The monthly rate of infection-related physician visits and prescriptions for anti-infectives filled, and the likelihood of hospital admissions for infections, were compared between populations using negative binomial regression and logistic regression. Models were adjusted for sex, age, year of index date, socioeconomic status, use of immunomodulators and immunosuppressive therapies for non-MS indications, and number of comorbid conditions. Differences in association by sex and age were examined by subgroup analyses. To account for disease modifying drug (DMD) use in MS patients, follow-up was censored at DMD initiation in complimentary analyses.
Results: We identified 7,179 persons with MS and 35,837 matched controls (mean age 45.4 years; 73.8% women). During follow-up, people with MS had 41% more infection-related physician visits (adjusted rate ratio [aRR] 1.41; 95%CI 1.36-1.47), filled 57% more prescriptions for anti-infectives (aRR 1.57; 95%CI 1.49-1.65), and were more likely to be hospitalized for infections (adjusted odds ratio [aOR] 2.40; 95%CI 2.17-2.66) than their matched controls. The difference in health care utilization was greater among men than women and increased with age. Censoring at DMD initiation did not change the interpretation of the findings. Among the most common infections, people with MS had significantly more medical encounters for urinary tract infections, pneumonia, intestinal infectious diseases, infections of the skin, and sepsis.
Conclusion: Our findings indicated an increased infection-related health care utilization in both the outpatient and inpatient setting in people with MS. These results have relevance for the care of people with MS.
Disclosure:
J.M.A. Wijnands: Nothing to disclose.
E. Kingwell: Nothing to disclose.
F. Zhu: Nothing to disclose.
Y. Zhao: Dr. Zhao receives research funding from the NMSS, and received funding from the CIHR, the MSSOC, and the Milan & Maureen Ilich Foundation.
J.D. Fisk: Dr. Fisk receives funding from the Canadian Institutes of Health Research (CIHR), MS Society of Canada, National Multiple Sclerosis Society and the Dalhousie Medical Research Foundation; consultation and distribution royalties from MAPI Research Trust, as well as speakers honoraria and travel expenses from EMD Serono (2013, 2014).
C. Evans: Nothing to disclose.
R.A. Marrie: Dr. Marrie has funding from the Canadian Institutes of Health Research, Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, Rx & D Health Research Foundation, Research Manitoba and sanofi-aventis (clinical trial).
H. Tremlett: Dr. Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis. She has received research support from: the Multiple Sclerosis Society of Canada, the Michael Smith Foundation, for Health Research Scholar, the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, and the UK MS Trust; speaker honoraria and/or travel expenses to attend conferences, from the Consortium of MS Centres (2013), the National MS Society (2012, 2014), Bayer Pharmaceuticals (2010), Teva Pharmaceuticals (2011), ECTRIMS (2011, 2012, 2013, 2014, 2015), UK MS Trust (2011), the Chesapeake Health Education Program, US Veterans Affairs (2012), Novartis Canada (2012), Biogen Idec (2014), American Academy of Neurology (2013, 2014, 2015). Speaker honoraria are either, declined or donated to an MS charity or used as an unrestricted grant by her research group.