High prevalence of comorbidities at diagnosis in immigrants with multiple sclerosis

Abstract

Background: Multiple sclerosis (MS) has been associated with certain comorbidities in general population studies, but it is unknown how comorbidity may affect immigrants with MS. Objective: To compare prevalence of comorbidities in immigrants and long-term residents at MS diagnosis, and in matched control populations without MS. Methods: We identified incident MS cases using a validated definition applied to health administrative data in Ontario, Canada, from 1994 to 2017, and categorized them as immigrants or long-term residents. Immigrants and long-term residents without MS (controls) were matched to MS cases 3:1 on sex, age, and geography. Results: There were 1534 immigrants and 23,731 long-term residents with MS matched with 4585 and 71,193 controls, respectively. Chronic obstructive pulmonary disease (COPD), diabetes, hypertension, ischemic heart disease, migraine, epilepsy, mood/anxiety disorders, schizophrenia, inflammatory bowel disease (IBD), and rheumatoid arthritis were significantly more prevalent among immigrants with MS compared to their controls. Prevalence of these conditions was generally similar comparing immigrants to long-term residents with MS, although COPD, epilepsy, IBD, and mood/anxiety disorders were less prevalent in immigrants. Conclusion: Immigrants have a high prevalence of multiple comorbidities at MS diagnosis despite the “healthy immigrant effect.” Clinicians should pay close attention to identification and management of comorbidity in immigrants with MS.

Etiology, effects and management of comorbidities in multiple sclerosis: recent advances

“…Other special populations with MS, including underrepresented ethnic and immigrant populations, also seem disproportionately affected by comorbidity. Although immigrants often have fewer medical conditions than the general population (‘the healthy immigrant effect’), immigrants with MS in Ontario, Canada had a higher prevalence of mood and anxiety disorders, migraines, diabetes, IHD, and chronic obstructive pulmonary disease compared to controls ( 21 ). In studies from the United States, depression and anxiety were more frequent in Black and Hispanic/Latinx individuals with MS ( 22 , 23 ).…”

Comorbidity in the aging population with multiple sclerosis: a Danish nationwide study

“…Immigrants and descendants may have different characteristics such as socioeconomic factors like educational level, income, and family structure influencing the risk of comorbidities, but also a different susceptibility for MS and comorbidities in general ( 51 ). A study investigating comorbidities found a higher prevalence among immigrants compared to long-term residents underlining the importance of taking ethnicity into account when investigating the consequences of MS ( 52 ).…”

The Barancik lecture: Comorbidity in multiple sclerosis—Looking backward, looking forward

“…8,16 As compared to long-term residents, immigrants to Ontario, Canada have an increased prevalence of comorbidity at the time MS is diagnosed, including mood/anxiety disorders, schizophrenia, diabetes, hypertension, ischemic heart disease, chronic lung disease, migraine, epilepsy, inflammatory bowel disease, and rheumatoid arthritis. 20 Lower socioeconomic status is associated with an increased incidence and prevalence of psychiatric comorbidities including depression, anxiety, bipolar disorder, and schizophrenia. 21 It is also associated with an increased incidence and prevalence of physical comorbidities.…”

“…As compared to long-term residents, immigrants to Ontario, Canada have an increased prevalence of comorbidity at the time MS is diagnosed, including mood/anxiety disorders, schizophrenia, diabetes, hypertension, ischemic heart disease, chronic lung disease, migraine, epilepsy, inflammatory bowel disease, and rheumatoid arthritis. 20 …”