Abstract
Few studies have investigated the factors associated with assisted ventilation use in amyotrophic lateral sclerosis (ALS) in western countries with a relatively small number of participants. This study aimed to evaluate the factors associated with assisted ventilation use using a large nationwide cohort covering the entire Korean population. We selected patients with primary or secondary diagnoses of ALS (ICD-10 code: G12.21) and a registration code for ALS (V123) in the rare intractable disease registration program. Covariates included in the analyses were age, sex, socioeconomic status and medical condition. Factors associated with non-invasive ventilation (NIV) and tracheostomy invasive ventilation (TIV) were evaluated. Logistic regression analyses were performed using odds ratios and 95% confidence intervals. In total, 3057 patients with ALS were enrolled. During the 6-year follow-up period, 1228 (40%) patients started using assisted ventilation: 956 with NIV and 272 with TIV. There was no significant difference in the assisted ventilation use according to sex, whereas different patterns of discrepancies were noted between the sexes: Females living in non-metropolitan areas showed decreased use of assisted ventilation, whereas high income levels showed a positive relationship with assisted ventilation use only in males. Patients aged ≥ 70 years showed decreased use of NIV. NIV use was more affected by socioeconomic status than TIV, whereas TIV showed a significant relationship with medical conditions such as nasogastric tube insertion and gastrostomy. We found that various factors, including age, socioeconomic status, and medical condition, were related with assisted ventilation use. Understanding the pattern of assisted ventilation use would help set optimal management strategies in patients with ALS.
Highlights
Few studies have investigated the factors associated with assisted ventilation use in amyotrophic lateral sclerosis (ALS) in western countries with a relatively small number of participants
Patients with assisted ventilation had a higher incidence of nasogastric tube insertion, gastrostomy, tracheostomy, and pneumonia than those without assisted ventilation use
We analyzed 3057 patients with ALS to evaluate the factors associated with assisted ventilation use from a nationwide population-based database comprising the entire Korean population
Summary
Few studies have investigated the factors associated with assisted ventilation use in amyotrophic lateral sclerosis (ALS) in western countries with a relatively small number of participants. We found that various factors, including age, socioeconomic status, and medical condition, were related with assisted ventilation use. Abbreviations ALS Amyotrophic lateral sclerosis CCI Charlson Comorbidity Index CI Confidence interval FVC Forced vital capacity NHI National Health Insurance NIV Non-invasive ventilation OR Odds ratio RID Rare intractable diseases SES Socioeconomic status TIV Tracheostomy invasive ventilation. Over the past few decades, both invasive and non-invasive assisted ventilation methods have been attempted for ALS management, and a consensus has been reached on its beneficial effects on dyspnea, quality of life, and survival among patients with A LS2–5. Demographic factors such as sex, age and marital status, were suggested to affect NIV utilization[10,11]
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