Skip to main content
AAN.com
Research
May 6, 2020
infographic

Comorbid disease drives short-term hospitalization outcomes in patients with multiple sclerosis

Abstract

Objective

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.

Related Infographic

Comorbid Diseases are Associated with Readmission for Persons with Multiple Sclerosis

Get full access to this article

View all available purchase options and get full access to this article.

Study funding

This study was funded by the University of Pennsylvania Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research.

References

1.
Marrie RA, Bernstein CN, Peschken CA, et al. Health care utilization before and after intensive care unit admission in multiple sclerosis. Mult Scler Relat Disord 2015;4:296–303.
2.
Marrie RA, Elliott L, Marriott J, et al. Dramatically changing rates and reasons for hospitalization in multiple sclerosis. Neurology 2014;83:929–937.
3.
Miller AE, Macdonell R, Comi G, et al. Teriflunomide reduces relapses with sequelae and relapses leading to hospitalizations: results from the TOWER study. J Neurol 2014;261:1781–1788.
4.
Thomas NP, Curkendall S, Farr AM, Yu E, Hurley D. The impact of persistence with therapy on inpatient admissions and emergency room visits in the US among patients with multiple sclerosis. J Med Econ 2016;19:497–505.
5.
Marrie RA, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. Comorbidity delays diagnosis and increases disability at diagnosis in MS. Neurology 2009;72:117–124.
6.
Zhang T, Tremlett H, Leung S, et al. Examining the effects of comorbidities on disease-modifying therapy use in multiple sclerosis. Neurology 2016;86:1287–1295.
7.
Marrie RA, Elliott L, Marriott J, Cossoy M, Tennakoon A, Yu N. Comorbidity increases the risk of hospitalizations in multiple sclerosis. Neurology 2015;84:350–358.
8.
NRD Database Documentation. Healthcare Cost and Utilization Project (HCUP). December 2019. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/db/nation/nrd/nrddbdocumentation.jsp. Accessed January 8, 2020.
9.
What Is HCUP? Healthcare Cost and Utilization Project (HCUP). December 2019. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/db/nation/nrd/nrddbdocumentation.jsp. Accessed January 8, 2020.
10.
Healthcare Cost and Utilization Project (HCUP). HCUP Methods Series: Calculating Nationwide Readmissions Database (NRD) Variances Report # 2017-01 [online]. Available at: www.hcup-us.ahrq.gov/reports/methods/2017-01.pdf. Accessed January 8, 2020.
11.
St Germaine-Smith C, Metcalfe A, Pringsheim T, et al. Recommendations for optimal ICD codes to study neurologic conditions: a systematic review. Neurology 2012;79:1049–1055.
12.
Menendez ME, Neuhaus V, van Dijk CN, Ring D. The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res 2014;472:2878–2886.
13.
Moore BJ, White S, Washington R, Coenen N, Elixhauser A. Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: the AHRQ Elixhauser comorbidity index. Med Care 2017;55:698–705.
14.
van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care 2009;47:626–633.
15.
Compston A, Coles A. Multiple sclerosis. Lancet 2002;359:1221–1231.
16.
Harbo HF, Gold R, Tintore M. Sex and gender issues in multiple sclerosis. Ther Adv Neurol Disord 2013;6:237–248.
17.
Association SS. Medicare [online]. Available at: www.ssa.gov/pubs/EN-05-10043.pdf.
18.
Doraiswamy PM, Leon J, Cummings JL, Marin D, Neumann PJ. Prevalence and impact of medical comorbidity in Alzheimer's disease. J Gerontol A Biol Sci Med Sci 2002;57:M173–M177.
19.
Ho C, Feng L, Fam J, Mahendran R, Kua EH, Ng TP. Coexisting medical comorbidity and depression: multiplicative effects on health outcomes in older adults. Int Psychogeriatr 2014;26:1221–1229.
20.
Tam AKH, Bayley MT. A narrative review of the impact of medical comorbidities on stroke rehabilitation outcomes. Disabil Rehabil 2018;40:1842–1848.
21.
Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med 2009;7:357–363.
22.
Marrie RA, Elliott L, Marriott J, et al. Effect of comorbidity on mortality in multiple sclerosis. Neurology 2015;85:240–247.
Letters to the Editor

Information & Authors

Information

Published In

Neurology® Clinical Practice
Volume 10Number 3June 2020
Pages: 255-264

Publication History

Received: July 10, 2018
Accepted: March 10, 2020
Published online: May 6, 2020
Published in print: June 2020

Permissions

Request permissions for this article.

Disclosure

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

Adys Mendizabal, 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:
1.
NONE
Legal Proceedings:
1.
NONE
Dylan P. Thibault, 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:
1.
NONE
Legal Proceedings:
1.
NONE
James A. Crispo, PhD
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:
1.
NONE
Legal Proceedings:
1.
NONE
Adina Paley
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:
1.
NONE
Legal Proceedings:
1.
NONE
Allison W. Willis, 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.
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:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Willis [email protected]
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.

Metrics & Citations

Metrics

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Recent Studies Highlight the Burden of Comorbidities in Multiple Sclerosis, British Journal of Neuroscience Nursing, 16, 5, (203-208), (2020).https://doi.org/10.12968/bjnn.2020.16.5.203
    Crossref
Loading...

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to get full access to it.

Purchase Access, $39 for 24hr of access

View options

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Media

Figures

Other

Tables

Share

Share

Share article link

Share