Bo Nancy Yu

Mental comorbidity and multiple sclerosis: validating administrative data to support population-based surveillance

BackgroundWhile mental comorbidity is considered common in multiple sclerosis (MS), its impact is poorly defined; methods are needed to support studies of mental comorbidity. We validated and applied administrative case definitions for any mental comorbidities in MS.MethodsUsing administrative health data we identified persons with MS and a matched general population cohort. Administrative case definitions for any mental comorbidity, any mood disorder, depression, anxiety, bipolar disorder and schizophrenia were developed and validated against medical records using a a kappa statistic (k). Using these definitions we estimated the prevalence of these comorbidities in the study populations.ResultsCompared to medical records, administrative definitions showed moderate agreement for any mental comorbidity, mood disorders and depression (all k ≥ 0.49), fair agreement for anxiety (k = 0.23) and bipolar disorder (k = 0.30), and near perfect agreement for schizophrenia (k = 1.0). The age-standardized prevalence of all mental comorbidities was higher in the MS than in the general populations: depression (31.7% vs. 20.5%), anxiety (35.6% vs. 29.6%), and bipolar disorder (5.83% vs. 3.45%), except for schizophrenia (0.93% vs. 0.93%).ConclusionsAdministrative data are a valid means of surveillance of mental comorbidity in MS. The prevalence of mental comorbidities, except schizophrenia, is increased in MS compared to the general population.

Rising prevalence of vascular comorbidities in multiple sclerosis: validation of administrative definitions for diabetes, hypertension, and hyperlipidemia.

Background: Despite the importance of comorbidity in multiple sclerosis (MS), methods for comorbidity assessment in MS are poorly developed. Objective: We validated and applied administrative case definitions for diabetes, hypertension, and hyperlipidemia in MS. Methods: Using provincial administrative data we identified persons with MS and a matched general population cohort. Case definitions for diabetes, hypertension, and hyperlipidemia were derived using hospital, physician, and prescription claims, and validated in 430 persons with MS. We examined temporal trends in the age-adjusted prevalence of these conditions from 1984–2006. Results: Agreement between various case definitions and medical records ranged from kappa (κ) =0.51–0.69 for diabetes, κ =0.21–0.71 for hyperlipidemia, and κ =0.52–0.75 for hypertension. The 2005 age-adjusted prevalence of diabetes was similar in the MS (7.62%) and general populations (8.31%; prevalence ratio [PR] 0.91; 0.81–1.03). The age-adjusted prevalence did not differ for hypertension (MS: 20.8% versus general: 22.5% [PR 0.91; 0.78–1.06]), or hyperlipidemia (MS: 13.8% versus general: 15.2% [PR 0.90; 0.67–1.22]). The prevalence of all conditions rose in both populations over the study period. Conclusion: Administrative data are a valid means of tracking diabetes, hypertension, and hyperlipidemia in MS. The prevalence of these comorbidities is similar in the MS and general populations.

The utility of administrative data for surveillance of comorbidity in multiple sclerosis: a validation study.

Background: Although comorbidity is important in multiple sclerosis (MS), few validated methods for its assessment exist. We validated and applied administrative case definitions for several comorbidities in MS. Methods: Using provincial administrative data we identified persons with MS and a matched general population cohort. Case definitions for chronic lung disease (CLD), epilepsy, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and migraine were developed using administrative data, and validated against medical records. We applied these definitions to estimate the age-standardized prevalence of these comorbidities in the MS and matched cohorts. Results: Versus medical records, administrative case definitions showed moderate agreement for CLD (ĸ = 0.41), migraine (ĸ = 0.51), and epilepsy (ĸ = 0.44), fair agreement for IBS (ĸ = 0.36) and could not be calculated for IBD (small sample size). The 2005 prevalence of CLD was similar in the MS (15.6%) and general populations (14.4%). The prevalence of the remaining comorbidities was higher in the MS than the general populations: epilepsy (4.12 vs. 1.12%), IBD (0.78 vs. 0.65%), IBS (12.2 vs. 6.80%) and migraine (23.0 vs. 16.5%). Conclusions: Administrative data are valid for tracking CLD, epilepsy, and migraine in MS. The prevalence of epilepsy, IBD, IBS and migraine is increased in MS versus the general population.

The incidence and prevalence of multiple sclerosis in Nova Scotia, Canada.

BACKGROUND Estimates of incidence and prevalence are needed to determine disease risk and to plan for health service needs. Although the province of Nova Scotia, Canada is located in a region considered to have a high prevalence of multiple sclerosis (MS), epidemiologic data are limited. OBJECTIVE We aimed to validate an administrative case definition for MS and to use this to estimate the incidence and prevalence of MS in Nova Scotia. METHODS We used provincial administrative claims data to identify persons with MS. We validated administrative case definitions using the clinical database of the provinces only MS Clinic; agreement between data sources was expressed using a kappa statistic. We then applied these definitions to estimate the incidence and prevalence of MS from 1990 to 2010. RESULTS We selected the case definition using ≥7 hospital or physician claims when >3 years of data were available, and ≥3 claims where less data were available. Agreement between data sources was moderate (kappa = 0.56), while the positive predictive value was high (89%). In 2010, the age-standardized prevalence of MS per 100,000 population was 266.9 (95% CI: 257.1- 277.1) and incidence was 5.17 (95% CI: 3.78-6.56) per 100,000 persons/year. From 1990-2010 the prevalence of MS rose steadily but incidence remained stable. CONCLUSIONS Administrative data provide a valid and readily available means of estimating MS incidence and prevalence. MS prevalence in Nova Scotia is among the highest in the world, similar to recent prevalence estimates elsewhere in Canada. Incidence et prévalence de la sclérose en plaques en Nouvelle-Écosse, Canada.

The Incidence and Prevalence of Thyroid Disease Do Not Differ in the Multiple Sclerosis and General Populations: A Validation Study Using Administrative Data

Background: Prior studies of a possible increased risk of autoimmune thyroid disease (AIT) in multiple sclerosis (MS) are inconsistent. We aimed to validate and apply administrative case definitions for the surveillance of AIT in MS. Methods: We used administrative health data to identify 4,192 persons with MS and an age-, sex- and geographically matched general population cohort (n = 20,940). We developed case definitions for AIT using International Classification of Disease-9/10 codes and prescription claims, compared them to medical records and applied them to estimate the incidence and prevalence of AIT. Results: When compared to medical records, the administrative case definition using ≥1 hospital or ≥2 physician or ≥2 prescription claims had a sensitivity of 73.5% and specificity of 98.4%. In 2005, the age-adjusted prevalence of AIT was 9.51% [95% confidence interval (CI) 8.46–10.6] in the MS population and 8.56% (95% CI 8.11–9.02) in the general population. The age-adjusted incidence of AIT per 100,000 persons per year was 422.8 (95% CI 204.4–641.3) in the MS population and 407.7 (95% CI 308.5–506.9) in the general population. From 1996 to 2005, the prevalence of AIT rose in both populations. Conclusion: Administrative data can be used for surveillance of AIT in MS. The incidence and prevalence of thyroid disease are similar in the MS and general populations.

Outpatient prescription practices in rural township health centers in Sichuan Province, China.

BackgroundSichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China.MethodsThis is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections.ResultsThe average medication cost per encounter was 16.30 Yuan (

Exploring the Implications of Small-Area Variation in the Incidence of Multiple Sclerosis

2.59). About 60% of the prescriptions contained Chinese patent medicine (CPM), and almost all prescriptions (98.07%) contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections.ConclusionsThe findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the lack of medical devices for disease diagnosis in those township health centers. The policy implication from this study is to enhance professional training in rational medication uses for rural doctors, improve hardware facilities for township health centers, promote health education to rural residents and establish a public reporting system to monitor prescription practices in rural township health centers, etc.

The incidence and prevalence of fibromyalgia are higher in multiple sclerosis than the general population: A population-based study

In this study, we describe the geospatial variation in the incidence of multiple sclerosis (MS) in Manitoba, Canada, and the sociodemographic characteristics associated with MS incidence. By using administrative health data, we identified all incident cases of MS in Manitoba from 1990 to 2006 (n = 2,290) and geocoded them to 230 neighborhoods in the City of Winnipeg and 268 municipalities in rural Manitoba. Age-standardized incidence rates for 1990-2006 (combined) were calculated for each region. By using the spatial scan statistic, we identified high-rate clusters in southwestern (incidence rate ratio (IRR) = 1.48) and central Winnipeg (IRR = 1.54) and low-rate clusters in north-central Winnipeg (IRR = 0.52) and northern Manitoba (IRR = 0.48). Multivariable Poisson regression showed a positive association between MS incidence rates and socioeconomic status. Despite our finding that MS incidence varied geographically and by socioeconomic status, the low Gini coefficient of 0.152 for MS incidence identified in this study suggests that the causes of MS are pervasive across all population groups. Searching for local-level causes of the disease may therefore not be as productive as investigating etiological factors operating at the population level. This may require an examination of macro-level differences in environmental exposures between high- and low-incidence regions of the world.

Persistence to disease-modifying therapies for multiple sclerosis in a Canadian cohort

OBJECTIVE Fibromyalgia adversely affects quality of life, yet little is known of the epidemiology of this condition in MS. We aimed to validate and apply administrative case definitions for fibromyalgia in MS. METHODS Using administrative health data we identified persons with MS and an age-, sex- and geographically-matched general population (GP) cohort. Case definitions for fibromyalgia were developed using ICD-9/10 codes, validated against medical records, and applied to evaluate the incidence and prevalence of fibromyalgia. RESULTS The case definition for fibromyalgia with ≥5 hospital or physician claims in 3 years had a sensitivity of 60%, specificity of 98%, and agreed moderately with medical records (κ=0.48). In 2005, the age-standardized prevalence of fibromyalgia was 6.82% (95% CI: 5.91-7.72) in the MS population and 3.04% (95% CI: 2.77-3.32) in the GP. After adjustment for age, sex and year, the incidence of fibromyalgia was 44% higher in the MS than the GP (IRR 1.44; 95% CI: 1.01-2.07). The incidence of fibromyalgia increased slightly over time in both populations. CONCLUSION The incidence and prevalence of fibromyalgia are higher in the MS population than the general population. Fibromyalgia should be considered in the management of pain in persons with MS.

Increasing incidence of anogenital warts with an urban-rural divide among males in Manitoba, Canada, 1990-2011.

Purpose To examine the long-term persistence to the first-line injectable disease-modifying therapies (DMTs) for multiple sclerosis (MS) and to identify the factors associated with nonpersistence. Patients and methods We used population-based administrative data from Manitoba, Canada. All adult subjects who were diagnosed with MS and dispensed a first-line injectable DMT (beta-interferon-1b, beta-interferon-1a, and glatiramer acetate) between 1996 and 2011 and had a minimum of 1 year of follow-up were included. The primary outcome was the median time to discontinuation of any DMT. The associations between potential predictors and persistence were estimated using multivariable Cox-proportional hazard models. Results Overall, 721 subjects were followed for a median of 7.8 years (interquartile range 6.1). The median time to discontinuation of all first-line DMTs was 4.2 years (25th and 75th percentile: 1.7, 10.6 years). Of the 451 (62.6%) subjects who discontinued their DMT during the study period, 259 (57.4%) eventually resumed or restarted a DMT. Subjects who were younger when starting a DMT, had prior MS-related hospitalizations, were more recently diagnosed with MS, or had a greater lag time between their MS diagnosis and DMT initiation were more likely to discontinue therapy. Conclusion Over half of the individuals receiving a DMT for MS in Manitoba remained on therapy for at least 4 years. DMT discontinuation occurred in 60% of the cohort, but most restarted a DMT within 1 year. While not all of the factors identified with discontinuing DMT are modifiable, they may help practitioners enhance MS care by identifying individuals who may be at particular risk for DMT discontinuation.