Multiple Sclerosis Journal - October 2017 - 1506
681198
research-article2016
MSJ0010.1177/1352458516681198Multiple Sclerosis JournalJMA Wijnands, E Kingwell
MULTIPLE
SCLEROSIS
JOURNAL
MSJ
Original Research Paper
Infection-related health care utilization among
people with and without multiple sclerosis
DOI: 10.1177/
https://doi.org/10.1177/1352458516681198
1352458516681198
https://doi.org/10.1177/1352458516681198
José MA Wijnands, Elaine Kingwell, Feng Zhu, Yinshan Zhao, John D Fisk,
Charity Evans, Ruth Ann Marrie and Helen Tremlett
© The Author(s), 2016.
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Multiple Sclerosis Journal
2017, Vol. 23(11) 1506-1516
Abstract
Background: Little is known about infection risk in multiple sclerosis (MS).
Objective: We examined infection-related health care utilization in people with and without MS.
Methods: Using population-based health administrative data from British Columbia, Canada, people
with MS were followed from their first demyelinating claim (1996-2013) until death, emigration, or
study end (2013). Infection-related hospital, physician, and prescription data of MS cases were compared
with sex-, age-, and geographically matched controls using adjusted regression models. Sex and age differences (18-39, 40-49, 50-59, 60+ years) were explored.
Results: Relative to 35,837 controls, 7179 MS cases were over twice as likely to be hospitalized for infection (adjusted odds ratio: 2.39; 95% confidence interval (CI): 2.16-2.65), had 41% more physician visits
(adjusted rate ratio (aRR): 1.41; 95% CI: 1.36-1.47), and filled 57% more infection-related prescriptions (aRR: 1.57; 95% CI: 1.49-1.65). Utilization was disproportionately higher in MS men than women
and was elevated across all ages. MS cases had nearly twice as many physician visits and two to three
times more hospitalizations for pneumonia, urinary system infections, and skin infections (aRRs ranged
from 1.6 to 3.3) and over twice as many hospitalizations for intestinal infections (aRR = 2.6) and sepsis
(aRR = 2.2).
Conclusion: Infection-related health care utilization was increased in people with MS across all age
groups, with a higher burden for men.
Correspondence to:
H Tremlett
Division of Neurology,
Faculty of Medicine,
University of British
Columbia, UBC Hospital,
Room S126, 2211 Wesbrook
Mall, Vancouver, BC V6T
2B5, Canada.
helen.tremlett@ubc.ca
Keywords: Multiple sclerosis, infections, health care utilization, population-based data
Ruth Ann Marrie
Departments of Internal
Medicine and Community
Health Sciences, University
of Manitoba, Winnipeg, MB,
Canada
Date received: 30 September 2016; revised: 31 October 2016; accepted: 1 November 2016
Introduction
Individuals with multiple sclerosis (MS) are thought
to be at a higher risk of infections than the general
population. Infections may have a significant influence on the lives of people with MS as they can
decrease quality of life,1 are associated with relapses,2
and have been reported as an important cause of hospitalization3,4 and mortality.5 Despite the potential
importance of infections in MS, surprisingly little is
known about the rates and types of infections that
prompt medical care in the MS population.
The limited literature on infection risk in MS has
focused on infections resulting in a hospitalization.3,4,6 However, most infections will not prompt a
hospitalization and, to date, little is known about the
1506
José MA Wijnands
Elaine Kingwell
Feng Zhu
Yinshan Zhao
Helen Tremlett
Division of Neurology,
Faculty of Medicine,
University of British
Columbia, Vancouver, BC,
Canada
John D Fisk
Departments of Psychiatry,
Psychology, and
Neuroscience, and Medicine,
Dalhousie University,
Halifax, NS, Canada
Charity Evans
College of Pharmacy and
Nutrition, University of
Saskatchewan, Saskatoon,
SK, Canada
frequency or range of infections prompting clinical
care in the outpatient setting. This study examined
the infection-related health care utilization as well as
the types of infections encountered in both the inpatient and outpatient care settings in people with and
without MS.
Methods
Study design and data sources
We performed a matched cohort study in British
Columbia (BC), Canada using population-based
health administrative data. Data linkage was performed at the individual level using personal health
numbers and was facilitated by Population Data BC, a
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Table of Contents for the Digital Edition of Multiple Sclerosis Journal - October 2017
Contents
Multiple Sclerosis Journal - October 2017 - Cover1
Multiple Sclerosis Journal - October 2017 - Cover2
Multiple Sclerosis Journal - October 2017 - Contents
Multiple Sclerosis Journal - October 2017 - ii
Multiple Sclerosis Journal - October 2017 - iii
Multiple Sclerosis Journal - October 2017 - 1436
Multiple Sclerosis Journal - October 2017 - 1437
Multiple Sclerosis Journal - October 2017 - 1438
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Multiple Sclerosis Journal - October 2017 - 1455
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Multiple Sclerosis Journal - October 2017 - 1537
Multiple Sclerosis Journal - October 2017 - 1538
Multiple Sclerosis Journal - October 2017 - 1539
Multiple Sclerosis Journal - October 2017 - 1540
Multiple Sclerosis Journal - October 2017 - 1541
Multiple Sclerosis Journal - October 2017 - 1542
Multiple Sclerosis Journal - October 2017 - 1543
Multiple Sclerosis Journal - October 2017 - 1544
Multiple Sclerosis Journal - October 2017 - 1545
Multiple Sclerosis Journal - October 2017 - 1546
Multiple Sclerosis Journal - October 2017 - 1547
Multiple Sclerosis Journal - October 2017 - 1548
Multiple Sclerosis Journal - October 2017 - 1549
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Multiple Sclerosis Journal - October 2017 - Cover3
Multiple Sclerosis Journal - October 2017 - Cover4
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