Contributions
Abstract: 198
Type: Oral
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Inverse comorbidity refers to the concept that certain diseases occur at lower rates than expected among persons with a given index disease. The objective of this study was to identify inverse comorbidity in MS.
Methods: We performed a combined case-control and cohort study in a total nationwide cohort of all registered Danish MS cases with clinical onset of MS between 1980 and 2005. We randomly matched each case to five population controls by gender, year of birth, and municipality on 1 January in the year of MS onset (index date). Individual-level information on comorbid diagnoses was obtained from multiple, independent nationwide registries and linked to the study population by unique personal identification numbers. The occurrence of comorbidities before and after the index date was assessed by following the study population from January 1977 to the index date, and from the index date through December 2012.We used logistic regression to calculate odds ratios (OR) and Cox regression to calculate hazard ratios (HR). Since the null-hypothesis in this context also included positive associations, we used one-tailed p-values. Using the Benjamini-Hochberg procedure, we adjusted significance limits and controlled for false discovery rate. We investigated each of eight pre-specified comorbidity categories: psychiatric, cerebrovascular, cardiovascular, lung, and autoimmune comorbidities, diabetes, cancer, and Parkinson"s disease.
Results: A total of 8.947 MS cases ad 44,735 controls were eligible for inclusion. Before the index date, we found a decreased risk of cerebrovascular comorbidity in MS cases compared with controls (OR 0.69 (95% CI 0.48-0.99, one-tailed p=0.0215)) although it did not formally meet the adjusted significance limit. After the index date, we found a decreased occurrence of chronic lung disease (asthma and chronic obstructive pulmonary disease) (HR 0,80 (95% CI 0.75-0.86, one-tailed p< 0.003)) and overall cancer (HR 0.88 (95% CI 0.81-0.95, one tailed p=0.0005)) among persons with MS. Both p-values were below the adjusted significance limits.
Conclusion: This study showed a decreased risk of cerebrovascular disease before onset of MS and a decreased risk of cancers and pulmonary diseases after onset of MS.Identification of inverse comorbidity and of its underlying mechanisms may provide new important entry points into the understanding of MS.
Disclosure: This study was funded by The Danish Multiple Sclerosis Society.
A. Thormann has served on a scientific advisory board for Biogen Idec and Novartis. She has received support for congress participation from Sanofi-Genzyme, BiogenIdec, Novartis, Teva, and UCB.
N. Koch-Henriksen has received honoraria for lecturing and participation in advisory councils, travel expenses for attending congresses and meetings, and financial support for monitoring the Danish MS Treatment Register from Bayer-Schering, Merck-Serono, BiogenIdec, TEVA, Sanofi-Aventis, and Novartis.
B. Laursen has nothing to disclose.
P.S. Sørensen has received personal compensation from Biogen Idec, Merck Serono, Novartis, Genmab, TEVA, GSK, and Sanofi-aventis, Genzyme as member of scientific advisory boards, steering committees or independent data monitoring boards in clinical trials, or as speaker at meetings. His research unit has received research support from Biogen Idec, Bayer Schering, Merck Serono, TEVA, Sanofi-aventis, Novartis, RoFAR, Roche, and Genzyme, the Danish Multiple Sclerosis Society, the Danish Medical Research Council, and the European Union Sixth Framework Programme: Life sciences, Genomics and Biotechnology for health.
M. Magyari has served on scientific advisory board for BiogenIdec and TEVA and has received honoraria for lecturing from BiogenIdec, MerckSerono, Novartis, and Teva. She has received support for congress participation from BiogenIdec, MerckSerono, Novartis, TEVA and Genzyme.
Abstract: 198
Type: Oral
Abstract Category: Clinical aspects of MS - Epidemiology
Background: Inverse comorbidity refers to the concept that certain diseases occur at lower rates than expected among persons with a given index disease. The objective of this study was to identify inverse comorbidity in MS.
Methods: We performed a combined case-control and cohort study in a total nationwide cohort of all registered Danish MS cases with clinical onset of MS between 1980 and 2005. We randomly matched each case to five population controls by gender, year of birth, and municipality on 1 January in the year of MS onset (index date). Individual-level information on comorbid diagnoses was obtained from multiple, independent nationwide registries and linked to the study population by unique personal identification numbers. The occurrence of comorbidities before and after the index date was assessed by following the study population from January 1977 to the index date, and from the index date through December 2012.We used logistic regression to calculate odds ratios (OR) and Cox regression to calculate hazard ratios (HR). Since the null-hypothesis in this context also included positive associations, we used one-tailed p-values. Using the Benjamini-Hochberg procedure, we adjusted significance limits and controlled for false discovery rate. We investigated each of eight pre-specified comorbidity categories: psychiatric, cerebrovascular, cardiovascular, lung, and autoimmune comorbidities, diabetes, cancer, and Parkinson"s disease.
Results: A total of 8.947 MS cases ad 44,735 controls were eligible for inclusion. Before the index date, we found a decreased risk of cerebrovascular comorbidity in MS cases compared with controls (OR 0.69 (95% CI 0.48-0.99, one-tailed p=0.0215)) although it did not formally meet the adjusted significance limit. After the index date, we found a decreased occurrence of chronic lung disease (asthma and chronic obstructive pulmonary disease) (HR 0,80 (95% CI 0.75-0.86, one-tailed p< 0.003)) and overall cancer (HR 0.88 (95% CI 0.81-0.95, one tailed p=0.0005)) among persons with MS. Both p-values were below the adjusted significance limits.
Conclusion: This study showed a decreased risk of cerebrovascular disease before onset of MS and a decreased risk of cancers and pulmonary diseases after onset of MS.Identification of inverse comorbidity and of its underlying mechanisms may provide new important entry points into the understanding of MS.
Disclosure: This study was funded by The Danish Multiple Sclerosis Society.
A. Thormann has served on a scientific advisory board for Biogen Idec and Novartis. She has received support for congress participation from Sanofi-Genzyme, BiogenIdec, Novartis, Teva, and UCB.
N. Koch-Henriksen has received honoraria for lecturing and participation in advisory councils, travel expenses for attending congresses and meetings, and financial support for monitoring the Danish MS Treatment Register from Bayer-Schering, Merck-Serono, BiogenIdec, TEVA, Sanofi-Aventis, and Novartis.
B. Laursen has nothing to disclose.
P.S. Sørensen has received personal compensation from Biogen Idec, Merck Serono, Novartis, Genmab, TEVA, GSK, and Sanofi-aventis, Genzyme as member of scientific advisory boards, steering committees or independent data monitoring boards in clinical trials, or as speaker at meetings. His research unit has received research support from Biogen Idec, Bayer Schering, Merck Serono, TEVA, Sanofi-aventis, Novartis, RoFAR, Roche, and Genzyme, the Danish Multiple Sclerosis Society, the Danish Medical Research Council, and the European Union Sixth Framework Programme: Life sciences, Genomics and Biotechnology for health.
M. Magyari has served on scientific advisory board for BiogenIdec and TEVA and has received honoraria for lecturing from BiogenIdec, MerckSerono, Novartis, and Teva. She has received support for congress participation from BiogenIdec, MerckSerono, Novartis, TEVA and Genzyme.