Higher healthcare use before paediatric multiple sclerosis onset: a nationwide cohort study
Notice bibliographique
Résumé
Evidence of increased healthcare use occurring before paediatric-onset multiple sclerosis presentation suggests a prodromal phase. However, little is known of its duration or features, and few studies have accessed a clinical cohort to examine the period before symptom onset. We compared annual rates of healthcare use before paediatric multiple sclerosis onset in clinical and administrative cohorts versus matched non-multiple sclerosis cohorts. We identified persons with paediatric-onset multiple sclerosis from the Swedish Multiple Sclerosis registry and population-based administrative data using a validated algorithm requiring ≥3 hospital or outpatient multiple sclerosis diagnostic codes recorded on separate dates. The index date was multiple sclerosis symptom onset, as recorded in the multiple sclerosis registry by a neurologist (clinical cohort) or the earliest demyelinating disease-related International Classification of Diseases code (administrative cohort). Individuals with age at index <18 years were matched with up to five individuals from the general population on sex, birth year, county of residence at the index date and residency time. Healthcare use was measured as hospital/outpatient diagnoses (International Classification of Diseases chapters) and prescription drug classes (Anatomical Therapeutic Chemical classification system, 2nd level). Yearly rates of hospital and outpatient visits (up to 17 years pre-index) and prescription fills (up to 14 years pre-index) were compared using Quasi-Poisson regression. The clinical/administrative cohorts included 233/206 paediatric-onset multiple sclerosis and 1151/1011 matched individuals, with a mean age at the index of 16 years (standard deviation: 2) in all four groups. In both cohorts, individuals with paediatric-onset multiple sclerosis exhibited elevated healthcare use predominantly 1-10 years pre-index, including, for example, higher prescriptions filled for corticosteroids for dermatological use (rate ratio range: 2.61-3.91) and outpatient visits for ill-defined signs/symptoms (rate ratio range: 2.17-8.64) and unassigned ICD codes (rate ratio range: 2.20-4.17). In the year pre-index, individuals with paediatric-onset multiple sclerosis in both cohorts exhibited higher rates of outpatient visits for neoplasms, nervous system disorders, sense organ conditions, ill-defined signs/symptoms and 'other health system contact' (rate ratio range: 2.05-18.00). In the same year, the clinical cohort also had higher rates of prescription fills for 'other gynecologicals' (4.08, 95% confidence interval: 1.04-16.09), and the administrative cohort had higher rates for prescriptions filled across eight drug classes (rate ratio range: 1.56-6.49). Healthcare use was higher primarily in the 1-10 years before paediatric-onset multiple sclerosis versus a matched cohort, suggestive of a prodromal phase. During this period, the paediatric-onset multiple sclerosis cohort was more often identified as having ill-defined signs/symptoms, neoplasms and skin-related issues.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».