Vascular Disease among Hospitalized Multiple Sclerosis Patients

Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn, USA.
Neuroepidemiology (Impact Factor: 2.48). 02/2008; 30(4):234-8. DOI: 10.1159/000128103
Source: PubMed

ABSTRACT We examined the prevalence of cardiac and cerebrovascular disease among hospitalized patients with and without multiple sclerosis (MS).
This study used the Statewide Planning and Research Cooperate System data set of over 15 million hospitalizations in New York City from 1988 through 2002. We identified MS patients 40-84 years of age who were hospitalized for reasons other than MS or related complications. MS patients were matched 1:2 on age, gender, race/ethnicity, and insurance. Outcomes included a principal discharge diagnosis of ischemic heart disease [International Classification of Diseases, Ninth Revision (ICD-9) 410-414], myocardial infarction (ICD-9 410), and ischemic stroke (ICD-9 434, 436). Multivariate logistic regression was used to compare vascular disease outcomes in MS and non-MS patients controlling for demographic and clinical factors.
Our study included 9,949 hospitalizations among MS patients and 19,898 hospitalizations for matched non-MS controls. MS patients were less likely to be hospitalized for ischemic heart disease (OR = 0.58, 95% CI = 0.51-0.66) or myocardial infarction (OR = 0.78, 95% CI = 0.64-0.96), but more likely to be hospitalized for ischemic stroke (OR = 1.66, 95% CI = 1.33-2.09) than matched non-MS controls.
MS patients have decreased rates of hospital admission for ischemic heart disease and myocardial infarction, but increased rates of hospitalization for ischemic stroke as compared to the general non-MS population.

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    • "In New York city, persons with MS aged 40–84 years were less likely to be hospitalized for IHD (OR 0.58, 95% CI: = 0.51– 0.66) or MI (OR 0.78, 95% CI: = 0.64–0.96) than matched hospital controls (Allen et al., 2008). Hospitalized elderly Medicare patients with MS had reported fewer hospital discharges for IHD than hospitalized persons without MS (Fleming and Blake, 1994). "
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    ABSTRACT: Background Studies suggest an altered risk of ischemic heart disease (IHD) in multiple sclerosis (MS), but data are limited. We aimed to validate and apply administrative case definitions to estimate the incidence and prevalence of IHD in MS. Methods Using administrative data we identified persons with incident MS (MSPOP) and a matched general population (GPOP) cohort. We developed case definitions for IHD using ICD-9/10 codes and prescription claims, compared them to medical records, then applied them to evaluate the incidence and prevalence of IHD. Results Agreement between medical records and the administrative definition using ≥1 hospital or ≥2 physician claims over 5 years was moderate (kappa=0.66; 95% CI: 0.42–0.90). In 2005, the age-standardized prevalence of IHD was 6.77% (95% CI: 5.48–8.07%) in the MSPOP and 6.11% (95% CI: 5.56–6.66%) in the GPOP. The prevalence of IHD was higher in the MSPOP than the GPOP among persons aged 20–44 years (prevalence ratio 1.87; 95% CI: 1.65–2.12) and aged 45–59 years (prevalence ratio 1.21; 95% CI: 1.08–1.35). The incidence of IHD was also higher in the MSPOP (incidence rate ratio 1.24; 95% CI: 0.97–1.59). Conclusions More than 5% of the MSPOP has IHD. The incidence of IHD was higher than expected in persons aged <60 years. Further evaluation of this issue is warranted.
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