How common is concurrent neurological and mood/anxiety disorder comorbidity over time? A population‐based cohort study in Ontario, Canada
Bibliographic record
Abstract
Abstract Background Neurological disorders and mental health conditions, including mood/anxiety disorders, are a leading cause of disability and healthcare use. These disorders have shared risk factors and commonly co‐occur in older adults. Mood/anxiety disorders are often under‐diagnosed and under‐treated among those with neurological disorders, potentially leading to more rapid symptom progression, worse health outcomes and increased health care use. We estimated the relative and absolute rates of neurological and mood/anxiety disorder comorbidity among adults in Ontario, Canada. Method We identified adults aged 40‐85 years on April 1st, 2002 in Ontario, Canada using health administrative databases. These individuals were followed for up to 14 years until March 31st, 2016. We estimated the association between between having a prior neurological disorder (dementia, Parkinson’s disease (PD), and stroke) or mood/anxiety disorder and developing a different, incident neurological or mood/anxiety disorder using cause‐specific hazard models. Exposure to prior disorders was modeled as a time‐varying covariate and death was considered a competing risk. Individuals who were not at risk for the specific incident outcome disorder were excluded from that model. Result All prior disorders were associated with increased rates of dementia: PD (adjHR= 4.05, 95%CI, 3.99‐4.11), stroke (adjHR=2.49, 95%CI, 2.47‐2.52), and mood/anxiety disorder (adjHR=1.79, 95%CI, 1.78‐1.80). Increased rates of PD were associated with prior dementia (adjHR=2.23, 95%CI, 2.17‐2.30) and mood/anxiety disorder (adjHR=1.77, 95% CI 1.74‐1.81), but not stroke (adjHR=1.04, 95% CI, 0.99 to 1.10). Rates of stroke were highest in persons with prior dementia (adjHR=1.56, 95% CI, 1.53 to 1.58) and showed more modest associations with PD (adjHR=1.21, 95% CI, 1.16 to 1.25) and mood/anxiety disorder (adjHR=1.09, 95% CI, 1.08 to 1.11). The associations were generally strongest in the six months following the prior disorder diagnosis, lowest in the interim periods (>six months to 10 years) and elevated in the later periods (10+ years) following diagnosis. Conclusion We observed associations between pairs of prior and incident neurological disorders and mood/anxiety disorder among middle‐ and older‐aged adults. Neurological and mental health comorbidity is common. This should be considered in clinical practice guidelines for these conditions and may necessitate care across multiple providers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.006 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".