Pre-Diagnostic Features of Multiple Sclerosis in a Diverse UK Cohort: A Nested Case-Control Study.

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Pooja Tank, Benjamin M Jacobs, Jonathan Bestwick, Ruth Dobson
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Abstract

Background: Many patients with Multiple Sclerosis (MS) experience nonspecific symptoms prior to diagnosis. This period-the 'MS prodrome'-has been described in socio-economically homogeneous cohorts to date. It remains unclear to what extent events prior to an MS diagnosis differ according to social determinants of health.

Methods: We conducted a retrospective, longitudinal, population-based nested case-control study using data from Clinical Practice Research Datalink (CPRD) Aurum. Associations between pre-diagnostic symptoms and MS risk were evaluated using multivariable logistic regression models in MS cases and matched controls. To determine whether associations differed by potential health determinants, we tested for statistical interactions and used stratified models.

Results: The study population consisted of 15,029 patients with MS (median index age 44.6, 80.3% female) and 81,027 age-matched controls. In the 5 years preceding diagnosis, MS cases were more likely than controls to have coded autonomic (OR 1.87 [1.80-1.94]), cognitive (OR 2.57 [2.06-3.20]), neurological (OR 7.91 [7.58-8.26]), pain (OR 2.21 [2.12-2.29]) and psychiatric (OR 1.75 [1.69-1.82]) symptoms. The direction of effect was consistent across gender, ethnicity, deprivation and location (urban vs. rural) strata, with over-representation of neurological symptoms in males and those living in urban areas. No statistically significant interaction between factors was found.

Conclusion: We report a consistent relationship between the occurrence of prodromal symptoms and MS risk across a diverse UK cohort. No associations were specific to a particular ethnic, gender or socio-economic group. These findings strengthen the concept of pre-diagnostic symptoms reflecting a potential opportunity to identify those at the earliest stages of MS.

多种英国队列中多发性硬化的诊断前特征:一项嵌套病例对照研究。
背景:许多多发性硬化症(MS)患者在诊断前经历非特异性症状。这一时期——“多发性硬化症前驱期”——迄今为止已经在社会经济同质队列中进行了描述。目前尚不清楚,根据健康的社会决定因素,MS诊断前的事件有多大程度的不同。方法:我们使用临床实践研究数据链(CPRD) Aurum的数据进行了一项回顾性、纵向、基于人群的巢式病例对照研究。在多发性硬化症病例和匹配对照中,使用多变量logistic回归模型评估诊断前症状与多发性硬化症风险之间的关联。为了确定关联是否因潜在的健康决定因素而不同,我们测试了统计相互作用并使用分层模型。结果:研究人群包括15029例MS患者(中位指数为44.6岁,80.3%为女性)和81027例年龄匹配的对照组。在诊断前5年,MS患者比对照组更有可能出现编码自主神经(OR 1.87[1.80-1.94])、认知(OR 2.57[2.06-3.20])、神经(OR 7.91[7.58-8.26])、疼痛(OR 2.21[2.12-2.29])和精神(OR 1.75[1.69-1.82])症状。影响的方向在性别、种族、贫困和地区(城市与农村)各阶层中是一致的,男性和生活在城市地区的人出现神经症状的比例过高。各因素间无统计学意义的交互作用。结论:我们报告了在不同的英国队列中前驱症状的发生与MS风险之间的一致关系。没有特定于某一种族、性别或社会经济群体的关联。这些发现加强了诊断前症状的概念,反映了在MS早期阶段识别这些症状的潜在机会。
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来源期刊
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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