Readmission is used as a quality indicator and is the primary target outcome for disease-modifying therapy (DMT) for multiple sclerosis (MS). However, data on readmissions for patients with MS are limited.
Methods
Using the US Nationwide Readmissions Database, we performed a retrospective cohort study of adults hospitalized for MS in 2014. Primary study outcomes were within 30- and 90-day readmissions. Descriptive analyses compared patient, clinical, and hospital variables readmission status. Multivariable logistic regression models estimated the associations between these variables and readmission.
Results
Of 16,629 individuals meeting the study criteria, most were women (73.7%), aged 35–54 years (48.0%), and Medicare program participants (36.8%). In total, 49.7% of inpatients with MS had 1–2 comorbid medical conditions and 23.7% had 3 or more. Having 3 or more comorbidity conditions associated with increased adjusted odds of the 30-day readmission (adjusted odds ratio [AOR] 1.92, 1.34–2.74). Anemia (AOR 1.62, 1.22–2.14), rheumatoid arthritis/collagen vascular diseases (AOR 2.20, 1.45–3.33), congestive heart failure (AOR 2.43, 1.39–4.24), chronic pulmonary disease (AOR 1.35, 1.02–1.78), diabetes with complications (AOR 2.27, 1.45–3.56), hypertension (AOR 1.25, 1.03–1.53), obesity (AOR 1.35, 1.05–1.73), and renal failure (AOR 1.68, 1.06–2.67) were associated with the 30-day readmission. Medicare insurance and nonroutine discharge were also associated with readmission, whereas patient characteristics (sex, age, and socioeconomic status) were not. The most frequent (26.7%) reason for readmission was multiple sclerosis. Ninety-day analyses produced similar findings.
Conclusions
Comorbid diseases were associated with the readmission for persons with multiple sclerosis. Evaluations of the real-world effectiveness for DMTs in reducing hospitalizations in patients with MS may need to consider comorbid disease burden and management.
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This study was funded by the University of Pennsylvania Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research.
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The authors report no disclosures relevant to the manuscript. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
Take-home Points
→ Almost 25% of all hospitalized patients with multiple sclerosis have 3 or more medical comorbidities.
→ Having more than 2 medical comorbidities was associated with hospital readmissions of patients with multiple sclerosis.
→ Rheumatoid arthritis/collagen vascular diseases, congestive heart failure, diabetes, hypertension, obesity, and renal failure were the comorbidities most often associated with the increased risk of readmission.
→ Together, these data underscore the need to better understand whether any common comorbid diseases in patients with MS could be disease or treatment related and underscore the potential role of optimized comorbid disease management in preventing negative health outcomes for individuals with MS.
Authors
Affiliations & Disclosures
AdysMendizabal, MD, MS
Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) ISPE Presenter Travel Award, (3) Canadian Institute of Health Research Travel Award
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) Northern Ontario Academic Medicine Association Clinical Innovation Opportunity Award
Stock/stock Options/board of Directors Compensation:
1.
(1) Public Health Sudbury & Districts Board of Health
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (AM, DPT, JAC, AP, AWW), University of Pennsylvania Perelman School of Medicine; Department of Neurology Translational Center of Excellence for Neuroepidemiology (DPT, JAC, AWW), Neurological Outcomes and Disparities Research, University of Pennsylvania Perelman School of Medicine; Department of Biostatistics (AWW), Epidemiology and Informatics, University of Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AWW), University of Pennsylvania Perelman School of Medicine; and Leonard Davis Institute of Health Economics (AWW), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
I have been an associate editor for the journal Pharmacoepidemiology and Drug Safety in August 2013.
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
Commercial. I am a site-investigator for an international multicenter clinical trial of a investigational drug for the treatment of Parkinson disease
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
National Institutes of Health/NINDS, R01 ns099129 Principle Investigator, September 2017- present
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
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