Physical and Mental Health Comorbidities Among Adults With Multiple Sclerosis

Cardiovascular comorbidities, mental health, and physical activity in persons with multiple sclerosis

This study examined the associations among cardiovascular comorbidities, symptoms of depression and anxiety, and physical activity in persons with multiple sclerosis. Participants with multiple sclerosis (N = 217) completed demographic, cardiovascular comorbidity, depression, and anxiety self-report measures, and wore an accelerometer for 7 days. We examined the bivariate, non-parametric correlations among the variables and conducted parametric, independent samples t-tests when examining the differences in variables based on cardiovascular comorbidity status. Bivariate correlation analysis indicated that there were statistically significant associations between anxiety scores, but not depression scores, and cardiovascular comorbidities. Physical activity, especially moderate-to-vigorous physical activity (MVPA), was correlated with cardiovascular comorbidities. There were small significant differences based on hyperlipidemia status in anxiety scores (p = 0.015, d = -0.42), MVPA (p < 0.001, d = 0.44), and steps/day (p < 0.001, d = 0.50), and based on hypertension status in anxiety scores (p = 0.010, d = -0.35), depression scores (p = 0.046, d = -0.26), MVPA (p = 0.003, d = 0.41), and steps/day (p < 0.001, d = 0.53). The findings indicate that there are significant associations among cardiovascular comorbidities, symptoms of depression and anxiety, and physical activity in persons with multiple sclerosis. Physical activity, specifically MVPA, may be a target for managing those outcomes in persons with multiple sclerosis.

Osteoarthritis and Neurological Disorder Diagnoses in Adults: A Meta-Analysis Examining Associations With Parkinson's Disease, Multiple Sclerosis, and Alzheimer's Disease

Osteoarthritis (OA) is a highly prevalent joint disorder that is emerging as a global threat to health. OA is associated with low-grade chronic systemic inflammation that can affect overall health, leading to a sedentary lifestyle and potentially increased risk of neurological disorders (ND) such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). A meta-analysis was conducted following the Preferred Reporting Items for 2020 Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Web of Science, and Embase databases were searched to identify records. The inclusion criteria for this analysis were original research articles reporting on OA and neurological disorder diagnoses (AD, PD, or MS) with non-OA comparator groups. Logarithmic odds ratios (LORs) were calculated and input into a random-effects meta-analysis using the restricted maximum-likelihood estimator. Subgroup analyses examined the associations between OA, AD, PD, and MS. A subsequent meta-regression analysis was performed to explore potential sources of heterogeneity, focusing on comorbidities and demographic factors. Publication bias was evaluated using funnel plots, Egger's test, and trim-and-fill analysis. Nine studies were included in this meta-analysis (six case-control designs, two cross-sectional designs, and one population-based cohort design) of 1,837,716 cases. The pooled odds ratio (OR) indicated a significant association between OA and ND diagnosis (OR = 1.246; confidence interval (CI): 1.01-1.53). Subsequent subgroup analyses were not statistically significant but indicated an association with PD (OR = 1.31, CI: 0.80-2.12), MS (OR = 1.12, CI: 0.80-2.81), and AD (OR = 1.50, CI: 0.80-2.81). This meta-analysis revealed that individuals with OA have approximately 25% higher odds of an accompanying ND diagnosis compared to those without OA. Importantly, these findings represent statistical associations only and do not imply causation or directionality but provide insight into factors, including shared risk factors, overlapping symptoms, or other underlying mechanisms that may influence the observed relationships.

Use of preventive service and potentially preventable hospitalization among American adults with disability: Longitudinal analysis of Traditional Medicare and commercial insurance

Objective

Examine the association between traditional Medicare (TM) vs. commercial insurance and the use of preventive care and potentially preventable hospitalization (PPH) among adults (18+) with disability [cerebral palsy/spina bifida (CP/SB); multiple sclerosis (MS); traumatic spinal cord injury (TSCI)] in the United States.

Methods

Using 2008-2016 Medicare and commercial claims data, we compared adults with the same disability enrolled in TM vs. commercial insurance [Medicare: n = 21,599 (CP/SB); n = 7,605 (MS); n = 4,802 (TSCI); commercial: n = 11,306 (CP/SB); n = 6,254 (MS); n = 5,265 (TSCI)]. We applied generalized estimating equations to address repeated measures, comparing cases with controls. All models were adjusted for age, sex, race/ethnicity, and comorbid conditions.

Results

Compared with commercial insurance, enrolling in TM reduced the odds of using preventive services. For example, adjusted odds ratios (OR) of annual wellness visits in TM vs. commercial insurance were 0.31 (95% confidence interval (CI): 0.28-0.34), 0.32 (95% CI: 0.28-0.37), and 0.19 (95% CI: 0.17-0.22) among adults with CP/SB, TSCI, and MS, respectively. Furthermore, PPH risks were higher in TM vs. commercial insurance. ORs of PPH in TM vs. commercial insurance were 1.50 (95% CI: 1.18-1.89), 1.83 (95% CI: 1.40-2.41), and 2.32 (95% CI: 1.66-3.22) among adults with CP/SB, TSCI, and MS, respectively. Moreover, dual-eligible adults had higher odds of PPH compared with non-dual-eligible adults [CP/SB: OR = 1.47 (95% CI: 1.25-1.72); TSCI: OR = 1.61 (95% CI: 1.35-1.92), and MS: OR = 1.80 (95% CI: 1.55-2.10)].

Conclusions

TM, relative to commercial insurance, was associated with lower receipt of preventive care and higher PPH risk among adults with disability.

Disparities in Morbidity After Spinal Cord Injury Across Insurance Types in the United States

OBJECTIVE

To compare the prevalence and incidence of, and adjusted hazards for comorbidities among adults with traumatic spinal cord injuries (TSCIs) across insurance types (private vs governmental insurance) in the United States.

PATIENTS AND METHODS

Privately insured (N=9081) and Medicare (N=7645) beneficiaries with a diagnosis of TSCI were included. Prevalence and incidence estimates of common psychological, cardiometabolic, and musculoskeletal morbidities were compared at baseline and at 4-years after index diagnosis, respectively. Survival models were used to quantify hazard ratios (HRs) for outcomes, controlling for insurance type, sociodemographic characteristics, and other comorbidities. Sensitivity analyses were conducted to determine the effects of insurance and race/ethnicity.

RESULTS

Adults with TSCIs on Medicare had a higher prevalence of any psychological (54.7% vs 35.4%), cardiometabolic (74.7% vs 70.1%), and musculoskeletal (72.8% vs 66.3%) morbidity than privately insured adults with TSCIs. Similarly, the 4-year incidences of most psychological (eg, depression: 37.6% [Medicare] vs 24.2% [private]), cardiometabolic (eg, type 2 diabetes: 22.5% [Medicare] vs 12.9% [private], and musculoskeletal (eg, osteoarthritis: 42.1% [Medicare] vs 34.6% [private]) morbidities were considerably higher among adults with TSCIs on Medicare. Adjusted survival models found that adults with TSCIs on Medicare had a greater hazard for developing psychological (HR, 1.40; 95% CI, 1.31-1.50) and cardiometabolic (HR, 1.21; 95% CI, 1.10-1.33) morbidities compared with privately insured adults with TSCI. There was evidence of both insurance and racial disparities.

CONCLUSION

Adults with TSCIs on Medicare had significantly higher prevalence and risk for developing common physical and mental health comorbidities, compared with privately insured adults with TSCIs.