Contributions
Abstract: 103
Type: Oral
Abstract Category: Clinical aspects of MS - 11 Comorbidity
Background: Emerging evidence suggests that comorbidity may influence disability outcomes in MS. Psychiatric comorbidity is common in MS, but its association with disability progression is unknown. We investigated this relationship in a large multi-clinic population.
Methods: This retrospective cohort study accessed prospectively collected information from linked clinical and population-based health administrative databases in the Canadian province of British Columbia. Persons with MS who had depression, anxiety, or bipolar disorder were identified via validated algorithms using physician and hospital visits. As these are chronic conditions, individuals were considered to have these comorbidities once they met the case definition, anytime from two years prior to MS onset to the end of follow-up. Generalized estimating equations were used to determine the association between psychiatric comorbidity and disability using all available EDSS scores, treated as a continuous dependent variable.
Results: 1250 incident cases of adult-onset MS were followed for a mean of 9.1 years. Most were women (75%) with a relapsing-onset disease course (94%). Nearly half (49%) met the case definition for a psychiatric disorder. Presence of psychiatric comorbidity (whether pre- or post-MS onset) was associated with a higher subsequent EDSS score (β-coefficient = 0.29, p< 0.0001) in a model adjusted for sex, socioeconomic status, count of physical comorbidities, and MS characteristics: disease course, onset age, disease duration, disease-modifying therapy use. Following stratification by sex, the relationship between psychiatric comorbidity and EDSS remained statistically significant among women (β-coefficient 0.35, p=0.0003), but not men (β-coefficient 0.08 p=0.685). Among all patients, the association was driven predominantly by the effect of depression, (β-coefficient=0.38, p < 0.0001). Following adjustment for confounders, there was no significant relationship between anxiety (β-coefficient=0.28, p=0.068, nor bipolar disorder (β-coefficient= 0.27, p=0.261) and EDSS.
Discussion: Presence of psychiatric comorbidities, which were common in our incident onset MS cohort, increased the risk of subsequent neurologic disability. This effect was particularly prominent for depression. Optimizing management of psychiatric comorbidities should be explored as a means of potentially mitigating disability progression in MS.
Disclosure: The study was sponsored by the Canadian Institutes of Health Research (CIHR: CBG 101829), the Rx & D Health Research Foundation, by a Don Paty Career Development Award from the Multiple Sclerosis Society of Canada to RAM, and by a Manitoba Research Chair from Research Manitoba to RAM.
KAM receives research funding from the Canadian Institutes of Health Research.
HT is funded by the Canada Research Chair program and in the last year has received research support from the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada and the Multiple Sclerosis Scientific Research Foundation.
JDF in the last year has received research support from the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, the National Multiple Sclerosis Society, the Nova Scotia Health Authority Research Fund and the Dalhousie Medical Research Fund.
TT received research funding from the MS Society of Canada from 2014-2016.
LK reports no disclosures.
RAM is funded by the Waugh Family Chair in Multiple Sclerosis, and has received research support from the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, the Multiple Sclerosis Scientific Research Foundation, the Consortium of MS Centers, and Crohn's and Colitis Canada.
Abstract: 103
Type: Oral
Abstract Category: Clinical aspects of MS - 11 Comorbidity
Background: Emerging evidence suggests that comorbidity may influence disability outcomes in MS. Psychiatric comorbidity is common in MS, but its association with disability progression is unknown. We investigated this relationship in a large multi-clinic population.
Methods: This retrospective cohort study accessed prospectively collected information from linked clinical and population-based health administrative databases in the Canadian province of British Columbia. Persons with MS who had depression, anxiety, or bipolar disorder were identified via validated algorithms using physician and hospital visits. As these are chronic conditions, individuals were considered to have these comorbidities once they met the case definition, anytime from two years prior to MS onset to the end of follow-up. Generalized estimating equations were used to determine the association between psychiatric comorbidity and disability using all available EDSS scores, treated as a continuous dependent variable.
Results: 1250 incident cases of adult-onset MS were followed for a mean of 9.1 years. Most were women (75%) with a relapsing-onset disease course (94%). Nearly half (49%) met the case definition for a psychiatric disorder. Presence of psychiatric comorbidity (whether pre- or post-MS onset) was associated with a higher subsequent EDSS score (β-coefficient = 0.29, p< 0.0001) in a model adjusted for sex, socioeconomic status, count of physical comorbidities, and MS characteristics: disease course, onset age, disease duration, disease-modifying therapy use. Following stratification by sex, the relationship between psychiatric comorbidity and EDSS remained statistically significant among women (β-coefficient 0.35, p=0.0003), but not men (β-coefficient 0.08 p=0.685). Among all patients, the association was driven predominantly by the effect of depression, (β-coefficient=0.38, p < 0.0001). Following adjustment for confounders, there was no significant relationship between anxiety (β-coefficient=0.28, p=0.068, nor bipolar disorder (β-coefficient= 0.27, p=0.261) and EDSS.
Discussion: Presence of psychiatric comorbidities, which were common in our incident onset MS cohort, increased the risk of subsequent neurologic disability. This effect was particularly prominent for depression. Optimizing management of psychiatric comorbidities should be explored as a means of potentially mitigating disability progression in MS.
Disclosure: The study was sponsored by the Canadian Institutes of Health Research (CIHR: CBG 101829), the Rx & D Health Research Foundation, by a Don Paty Career Development Award from the Multiple Sclerosis Society of Canada to RAM, and by a Manitoba Research Chair from Research Manitoba to RAM.
KAM receives research funding from the Canadian Institutes of Health Research.
HT is funded by the Canada Research Chair program and in the last year has received research support from the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada and the Multiple Sclerosis Scientific Research Foundation.
JDF in the last year has received research support from the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, the National Multiple Sclerosis Society, the Nova Scotia Health Authority Research Fund and the Dalhousie Medical Research Fund.
TT received research funding from the MS Society of Canada from 2014-2016.
LK reports no disclosures.
RAM is funded by the Waugh Family Chair in Multiple Sclerosis, and has received research support from the National Multiple Sclerosis Society, the Canadian Institutes of Health Research, the Multiple Sclerosis Society of Canada, the Multiple Sclerosis Scientific Research Foundation, the Consortium of MS Centers, and Crohn's and Colitis Canada.