Effects of physical comorbidities on disability progression in multiple sclerosis

Abstract

Objective: To examine the association between physical comorbidities and disability progression in multiple sclerosis (MS).

Methods: We conducted a retrospective cohort study using linked health administrative and clinical databases in 2 Canadian provinces. Participants included adults with incident MS between 1990 and 2010 who entered the cohort at their MS symptom onset date. Comorbidity status was identified with validated algorithms for health administrative data and was measured during the 1 year before study entry and throughout the study period. The outcome was the Expanded Disability Status Scale (EDSS) score as recorded at each clinic visit. We used generalized estimating equations to examine the association between physical comorbidities and EDSS scores over time, adjusting for sex, age, cohort entry year, use of disease-modifying drugs, disease course, and socioeconomic status. Meta-analyses were used to estimate overall effects across the 2 provinces.

Results: We identified 3,166 individuals with incident MS. Physical comorbidity was associated with disability; with each additional comorbidity, there was a mean increase in the EDSS score of 0.18 (95% confidence interval [CI] 0.09-0.28). Among specific comorbidities, the presence of ischemic heart disease (IHD) or epilepsy was associated with higher EDSS scores (IHD 0.31, 95% CI 0.01-0.61; epilepsy 0.68, 95% CI 0.11-1.26).

Conclusions: Physical comorbidities are associated with an apparent increase in MS disability progression. Appropriate management of comorbidities needs to be determined to optimize outcomes.

Figure 1. Association between an increase in the number of physical comorbidities and MS disability (EDSS) over the study period

A positive coefficient represents the additional disability burden of 1 comorbidity on average. The physical comorbidities of interest included diabetes mellitus, hypertension, hyperlipidemia, heart disease, chronic lung disease, and epilepsy. Results were obtained from generalized estimating equation models. Sex, disease course, cohort entry year, and socioeconomic status were included in the adjusted model. Age was the time scale. CI = confidence interval; EDSS = Expanded Disability Status Scale; MS = multiple sclerosis.

Figure 2. Association between each individual physical comorbidity and MS disability (EDSS) over the study period: findings based on the multivariable GEE model

Reference groups were patients without the relevant comorbidity. This multivariable model was adjusted for sex, disease course, cohort entry year, use of a disease-modifying drug, and socioeconomic status. Age was the time scale. CI = confidence interval; EDSS = Expanded Disability Status Scale; GEE = generalized estimating equation; MS = multiple sclerosis.