Physical and mental health comorbidity is common in people with multiple sclerosis: nationally representative cross-sectional population database analysis

Abstract

Background: Comorbidity in Multiple Sclerosis (MS) is associated with worse health and higher mortality. This study aims to describe clinician recorded comorbidities in people with MS.

Methods: 39 comorbidities in 3826 people with MS 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: People with MS 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 people with MS.

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

Figure 1

Association between number of physical conditions and presence of any mental health condition.

Figure 2

Odds ratios for individual mental conditions: people with MS (n = 3826) vs controls (n = 1,268,859). *Odds Ratios adjusted for Age, Sex and Deprivation Scores. Note on abbreviations [13]: Depression = Read code recorded in last 12 months OR ≥4 anti-depressant prescriptions (excluding low dose tricyclics) in last 12 months; Anxiety = Anxiety & other neurotic, stress related & somatoform disorders, Read code in last 12 months OR ≥ 4 anxiolytic/hypnotic prescriptions in last 12 months. OR ≥4 10/25 mg amitriptyline in last 12 months & do not meet the criteria for ‘Pain.’; Drugs Misuse = Other psychoactive substance misuse; Eating Disorder = Anorexia or Bulimia; Bipolar/Schizo = Schizophrenia (and related non-organic psychosis) or bipolar disorder, Read code ever recorded/recorded in last 12 months (code dependent) OR Lithium prescribed in last 168 days.

Figure 3

Odds ratios for individual physical conditions: people with MS (n = 3826) vs controls (n = 1,268,859). *Odds Ratios adjusted for Age, Sex and Deprivation Scores. Note on abbreviations [13]: Constipation = ≥4 laxative prescriptions in last year; Pain = ≥4 prescription only medicine analgesic prescriptions in last 12 months OR ≥4 specified anti-epileptics in the absence of an epilepsy Read code in last 12 months; Migraine = ≥4 prescription only medicine anti-migraine prescriptions in last year; Epilepsy = Read code ever recorded AND antiepileptic prescription in last 12 months; IBS = Read code ever recorded OR ≥ 4 prescription only medicine antispasmodic prescription in last 12 months; Parkinson’s Disease = Parkinson’s Disease and Parkinsonism; Psoriasis or Eczema = Read code ever recorded AND ≥ 4 related prescriptions in last 12 months (excluding simple emollients) Dyspepsia = ≥ 4 prescriptions in last 12 months excluding antacids AND NOT (≥4 NSAIDS OR ≥4 aspirin/clopidogrel) IBD = inflammatory bowel disease; PVD = Peripheral vascular disease; Stroke = Stroke and Transient ischaemic attack; COPD = Chronic obstructive pulmonary disease; CKD = Chronic kidney disease; Inflammatory Arthritis = Rheumatoid arthritis, other inflammatory polyarthropathies & systematic connective tissue disorders; Asthma = Read code ever recorded AND any prescription in last 12 months.