Validation of multiple sclerosis diagnoses in the Swedish National Patient Register

Murley, Chantelle; Friberg, Emilie; Hillert, Jan; Alexanderson, Kristina; Yang, Fei

doi:10.1007/s10654-019-00558-7

Cited by 27 publications

(21 citation statements)

References 25 publications

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“…It has fewer diagnostic errors among younger patients and a high level of accuracy for MS diagnoses. 33 A recent study confirmed 92.5% of all MS diagnosis in the NPR 34 and previous validation studies have reported more than 99% of all somatic hospital discharges are registered in the register and 85-95% of all inpatient diagnoses are valid. 33 In our study we used two MS diagnoses separated by at least six months which notably increased the accuracy.…”

Section: Discussionmentioning

confidence: 76%

Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden

Castelo-Branco¹,

Chiesa²,

Bengtsson³

et al. 2020

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Background Comorbidity is of significant concern in multiple sclerosis (MS). Few population-based studies have reported conditions occurring in MS after diagnosis, especially in contemporary cohorts. Objective To explore incident comorbidity, mortality and hospitalizations in MS, stratified by age and sex. Methods In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years) and 61,828 matched MS-free individuals were identified between 1 January 2008 and 31 December 2016, using national registers. Incidence rates (IRs) and incidence rate ratios (IRRs) with 95% CI were calculated for each outcome. Results IRs of cardiovascular disease (CVD) were higher among MS patients than MS-free individuals, (major adverse CVD: IRR 1.42; 95% CI 1.12–1.82; hemorrhagic/ischemic stroke: 1.46; 1.05–2.02; transient ischemic attack: 1.65; 1.09–2.50; heart failure: 1.55; 1.15–2.10); venous thromboembolism: 1.42; 1.14–1.77). MS patients also had higher risks of several non-CVDs such as autoimmune conditions (IRR 3.83; 3.01–4.87), bowel dysfunction (2.16; 1.86–2.50), depression (2.38; 2.11–2.68), and fractures (1.32; 1.19–1.47), as well as being hospitalized and to suffer from CVD-related deaths ((1.91; 1.00–3.65), particularly in females (3.57; 1.58–8.06)). Conclusion MS-patients experience a notable comorbidity burden which emphasizes the need for integrated disease management in order to improve patient care and long-term outcomes of MS.

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Section: Discussionmentioning

confidence: 76%

Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden

Castelo-Branco¹,

Chiesa²,

Bengtsson³

et al. 2020

Multiple Sclerosis Journal - Experimental, Translational and Cl

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“…A patient with a first-ever hospital visit concerning amyotrophic lateral sclerosis, multiple sclerosis or Parkinson’s disease was defined as an incident case, and the date of the first hospital visit was defined as the date of diagnosis. Such definitions of amyotrophic lateral sclerosis, multiple sclerosis and Parkinson’s disease have been estimated previously, with a positive predictive value of 91% for amyotrophic lateral sclerosis (in Stockholm during 2013–2014) ( Mariosa et al , 2017 ), 92.5% for multiple sclerosis (in Sweden during 2001–2013) ( Murley et al , 2019 ) and 70.8% for Parkinson’s disease (in Sweden during 1964–2009 based on inpatient care alone) ( Feldman et al , 2012 ). For each case, we then randomly selected five controls who were individually matched to the case by age, sex and county of residence, using the method of incidence density sampling.…”

Section: Methodsmentioning

confidence: 75%

Creatinine and C-reactive protein in amyotrophic lateral sclerosis, multiple sclerosis and Parkinson’s disease

Cui

Sun

Pawitan

et al. 2020

Brain Communications

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Serum creatinine and C-reactive protein have been proposed as potential biomarkers for neurodegenerative diseases, including amyotrophic lateral sclerosis, multiple sclerosis, and Parkinson’s disease. However, longitudinal studies investigating temporal patterns of these biomarkers, including the phase before diagnosis, are rare. We performed a case-control study including all newly diagnosed patients with amyotrophic lateral sclerosis (N = 525), multiple sclerosis (N = 1,815), or Parkinson’s disease (N = 3,797) during 2006-2013 in Stockholm, Sweden, who participated in the Stockholm CREAtinine Measurements (SCREAM) project. For each case, we randomly selected up to five controls from SCREAM that were individually matched to the case by age, sex, and county of residence (N = 2625 for amyotrophic lateral sclerosis, N = 9,063 for multiple sclerosis, and 18,960 for Parkinson’s disease). We collected for both the cases and controls testing results of serum creatinine and C-reactive protein performed by healthcare providers in Stockholm during the study period. Median levels of creatinine and C-reactive protein were visualized using locally weighted smoothing curves among cases and controls. A linear mixed model was also applied to explore temporal changes within an individual. Compared to controls, patients with amyotrophic lateral sclerosis had lower levels of creatinine from two years before diagnosis onward. In contrast, patients with amyotrophic lateral sclerosis had lower levels of C-reactive protein before diagnosis but higher levels after diagnosis, compared to controls. Focusing the two years before to two years after diagnosis, patients with amyotrophic lateral sclerosis displayed statistically significantly decreasing level of creatinine from one year before diagnosis until two years after diagnosis, whereas increasing level of C-reactive protein from diagnosis until two years after diagnosis. There were no similar patterns noted among patients with multiple sclerosis or Parkinson’s disease, or the controls of the three patient groups. Patients with amyotrophic lateral sclerosis display distinct temporal patterns of creatinine and C-reactive protein before and after diagnosis, compared to amyotrophic lateral sclerosis-free controls or patients with multiple sclerosis and Parkinson’s disease.

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“…A limitation of the study is the lack of validation for patients with concurrent ALS and autoimmune disease, because of the historical and nationwide nature of data. However, the validity of ALS diagnosis ( 16) and many autoimmune diseases, including multiple sclerosis (36), rheumatoid arthritis (37), Guillain-Barr e syndrome (38), diabetes (39), psoriasis (40), ulcerative colitis and Crohn's disease (41), polymyalgia rheumatica (42), ankylosing spondylitis (43), celiac disease (44), Wegener's granulomatosis (45), Sarcoidosis (46), Addison's disease (47), pemphigoid (48), is known to be satisfactory in the Swedish Patient Register. The similar results noted in the sensitivity analyses where we used more strict definitions of autoimmune diseases also alleviated the concern to some extent.…”

Section: Discussionmentioning

confidence: 99%

Associations between autoimmune diseases and amyotrophic lateral sclerosis: a register-based study

Cui

Longinetti

Larsson

et al. 2020

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration

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Objective: To assess the associations of 43 autoimmune diseases with the subsequent risk of ALS and further evaluate the contribution of familial confounding to these associations. Methods: We conducted a nationwide register-based nested case-control study including 3561 ALS patients diagnosed during 1990-2013 in Sweden and 35,610 controls that were randomly selected from the general population and individually matched to the cases on age, sex, and county of birth. To evaluate the contribution of familial factors on the studied association, we additionally studied the first-degree relatives (siblings and children) of ALS patients and their controls. Results: Patients with ALS had a 47% higher risk of being previously diagnosed with autoimmune disease (OR 1.47, 95% confidence interval [CI] 1.31-1.64), compared with controls. A positive association was noted for several autoimmune diseases, including myasthenia gravis, polymyositis or dermatomyositis, Guillain-Barre syndrome, type 1 diabetes diagnosed younger than 30 years, multiple sclerosis, and hypothyreosis. The increased risk of any autoimmune disease was greatest during the year before ALS diagnosis, likely due to misdiagnosis. A statistically significantly increased risk was also noted during 2-5 years, but not earlier, before ALS diagnosis. First-degree relatives of ALS patients had however no increased risk of autoimmune diseases compared with first-degree relatives of controls. Conclusions: Although it is difficult to completely remove the potential effects of misdiagnosis, there is likely a positive association between autoimmune disease (such as type 1 diabetes and multiple sclerosis) and ALS, which is not fully explained by shared familial confounding factors.

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Validation of multiple sclerosis diagnoses in the Swedish National Patient Register

Cited by 27 publications

References 25 publications

Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden

Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden

Creatinine and C-reactive protein in amyotrophic lateral sclerosis, multiple sclerosis and Parkinson’s disease

Associations between autoimmune diseases and amyotrophic lateral sclerosis: a register-based study

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