Hospitalization rates and discharge status in multiple sclerosis

Abstract

Management of multiple sclerosis (MS) has shifted from supportive to disease modifying therapy. Considering the increasingly widespread adoption of this approach in managing MS patients, we hypothesized that hospitalizations and surrogates of disease-related complications should have declined during the last decade. Methods. Using the Nationwide Inpatient Sample, hospitalizations for MS and associated secondary diagnoses and procedures as well as discharge status were examined. Time trends were examined for different age cohorts focusing on the period from 2001 to 2010. Results. During the preceding decade, annual hospitalizations for MS increased by 40%, with stable rates in all age groups except geriatric patients, who accounted for a significantly higher fraction of admissions. Nursing home transfers as a surrogate marker of disability remained unchanged for all age groups. Similarly, urinary tract infections, the need for skin debridement, or gastrostomy tube placement did not vary during the decade. Conclusion. During a time of increased adoption of disease modifying therapy, MS-related hospitalizations continued to increase and surrogate measures of disability in admitted patients remained stable, demonstrating the still significant impact of the disease on affected individuals.

Figure 1

(a) Annual admissions for MS for the decade between 2001 and 2010 separated for MS as primary diagnosis (white circles) of all admissions that included MS as a diagnosis (black circles); the insert shows percentage of change from baseline in 2001 in comparison to all hospitalizations (triangles). (b) Relative age distribution of MS-related admissions during the 10-year period based on predefined age cohorts.

Figure 2

Time-dependent changes in discharge status as surrogate measures of functional impairment: nursing home transfers and discharge to ongoing home care are plotted for all the admissions with MS (a), admissions of patients 18–44 years (b) and 45–64 years (c).

Figure 3

Time trends in surrogate measures of disease-related complications. The relative frequency of urinary tract infections (black circles) and adverse medication effects (black squares) as secondary diagnoses or wound debridement (white circles) and gastrostomy placement (white squares) were normalized for the total number of admissions and plotted as a function of time.