Thursday, 26 June 2014

Co-morbidities and MS

MSers are more likely to have multiple diagnoses. #MSBlog #MSResearch

"The study below using data from the Scottish Primary Care dataset shows that MSers are much more likely to have one or more comorbidities, or other diseases. The problem with this study is that it implies these other disease are independent of MS, when they are clearly not and a large number of them are manifestations of MS. For example, the list of mental health conditions includes depression, anxiety, stress related & somatoform disorders, drugs misuse, anorexia or bulimia, bipolar disorder and schizophrenia. All these disorders could be a manifestation of MS. What is interesting is that MSers are less likely to be diagnosed with coronary heart disease or hypertension. The latter comes as a surprise to me; I was under the impression that MSers were at higher risk of coronary heart disease, mainly due to the common association with smoking and obesity, both of which are commoner in MSers that the general population. I will need to check to see if this finding can be reproduced in other datasets. What this study does show is that MS is a very complex disease and has numerous associated comorbidities that all need addressing. This has resource indications and needs to be taken into account with any healthcare service development. Do you have a problem with associated diseases? Does your doctor treats them as part of your MS or does he/she treat them as being unrelated to MS?"



Epub: Simpson et al. Physical and mental health comorbidity is common in people with multiple sclerosis: nationally representative cross-sectional population database analysis. BMC Neurol. 2014;14(1):128.

BACKGROUND: Comorbidity in MS is associated with worse health and higher mortality. This study aims to describe clinician recorded comorbidities in MSers.

METHODS: 39 comorbidities in 3826 MSers aged >=25 years were compared against 1,268,859 controls. Results were analysed by age, gender, and socioeconomic status, with unadjusted and adjusted Odds Ratios (ORs) calculated using logistic regression.

RESULTS: MSers were more likely to have one (OR 2.44; 95%CI 2.26-2.64), two (OR 1.49; 95%CI 1.38-1.62), three (OR 1.86; 95% CI 1.69-2.04), four or more (OR 1.61; 95%CI 1.47-1.77) non-MS chronic conditions than controls, and greater mental health comorbidity (OR 2.94; 95%CI 2.75-3.14), which increased as the number of physical comorbidities rose. Cardiovascular conditions, including atrial fibrillation (OR 0.49; 95%CI 0.36-0.67), chronic kidney disease (OR 0.51; 95%CI 0.40-0.65), heart failure (OR 0.62; 95%CI 0.45-0.85), coronary heart disease (OR 0.64; 95%CI 0.52-0.71), and hypertension (OR 0.65; 95%CI 0.59-0.72) were significantly less common in MSers.

CONCLUSION: MSers have excess multiple chronic conditions, with associated increased mental health comorbidity. The low recorded cardiovascular comorbidity warrants further investigation.

3 comments:

  1. Prof G where do they get the statistics? You say you are surprised at a lower risk of heart disease, I'm not. I have so many co-morbidities I take a patient history document to all my outpatient appointments. Recently I attended a new clinic for a serious disease totally unconnected to MS, gave the doctor my written history and MS was at the top of the list. Imagine my amazement when he asked me why I couldn't walk. A lot of doctors only show an interest in their own speciality, So if they are not concerned with your MS they are hardly going to complete the statistical data.

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  2. I believe artheroscerosis is MS-related no matter what this finding says.

    Many of the morbidities are just a consequence of MS like depression (who would not get one after a diagnosis) or anxiety (who would not get that one with the prospect of a wheelchair) or problems with kidneys (who would not get that after daily use of toxic meds)? etc. Common-sense really.

    Don't scatter your brain into too many associations like obesity, smoking, anxiety - they will not explain the cause of MS in my opinion.

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  3. Surprised that people with long - term life limiting conditions like ms get anxious and depressed? Thanks for elucidating the term 'multiple' in multiple sclerosis.

    Hospitalised for a week last year after a fall in part resulting from iron deficiency aneamia, I could rattle off a long list of sub-clinical 'co-morbidities' that are ms related yet aren't necessarily caused by ms; but the fact that I now have ms makes it harder to avoid or tackle them - long walks and cycling etc, can't do that now.

    Nor does it help to have our concerns about sub-clinical symptoms dismissed as mild neuroses.

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