Abstract
We aimed to compare health care utilization of children with pediatric-onset multiple sclerosis to that of age, sex and geographically-matched children without multiple sclerosis. Using population-based administrative data from Ontario, Canada for the period 2003–2014, we applied a validated case definition to identify persons aged ≤18 years with multiple sclerosis. We identified up to 5 children without multiple sclerosis matched on sex, age, and region of residence. In each cohort, we determined annual rates of any hospitalization and physician services use. Using general linear models we compared utilization rates adjusting for age, sex, region, socioeconomic status and year. Subsequently, we limited the analysis to incident cases of multiple sclerosis and their matches, and compared rates of utilization in the year of multiple sclerosis diagnosis, and the three years thereafter. We identified 659 youth with multiple sclerosis (428 incident cases), and 3,294 matched controls. Two-thirds of both cohorts were female. After adjustment for sociodemographic factors and year, the multiple sclerosis cohort was more likely to be hospitalized than the matched cohort (odds ratio 15.2; 95%CI: 12.0, 19.1), and had higher rates of ambulatory physician visits (rate ratio 4.58; 95%CI: 4.26, 4.92). The odds of hospitalization (odds ratio 40.1; 95%CI: 27.1, 59.5) and physician visits (rate ratio 5.14; 95%CI: 4.63, 5.71) were markedly elevated in the year of MS diagnosis, declining thereafter but remaining elevated versus the matched cohort. Children with multiple sclerosis have substantially elevated rates of health care utilization as compared to matched children without multiple sclerosis, over calendar time and throughout the early disease course.
Highlights
Multiple sclerosis (MS) is a disease of the central nervous system which most commonly presents in adulthood
These population-based databases included the registered persons database, the hospital discharge abstract database (dates of admission and separation, discharge diagnoses recorded using 5-digit International Classification of Disease (ICD)-9 or ICD-10-CA codes, depending on the year), and the Ontario related to the following commercial sources: she has served on the scientific advisory board for Juno Therapeutics and is a relapse adjudicator for ACI
We identified 659 children and adolescents living with MS during the study period
Summary
Multiple sclerosis (MS) is a disease of the central nervous system which most commonly presents in adulthood. Affected adults have higher rates of health care utilization as compared to age and sex-matched adults without MS,[1, 2] but utilization in this population has changed over time, most notably due to a decrease in hospitalization rates.[1, 3] In about 5% of individuals with MS, the initial presentation is in childhood or adolescence. Several factors suggest that health care use may differ in the pediatric and adult MS populations. We aimed to compare health care utilization of children with pediatriconset MS with that of children without MS using population-based administrative (health claims) data
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