Comorbidities of Multiple Sclerosis Patients Treated at the Illinois Neurological Institute (INI) Multiple Sclerosis Center ws

Research Article

Austin J Mult Scler & Neuroimmunol. 2016; 3(1): 1024.

Comorbidities of Multiple Sclerosis Patients Treated at the Illinois Neurological Institute (INI) Multiple Sclerosis Center

Valenzuela MR¹, Cooley KL², Kimberly L², Gonia L², Taylor AJ¹, Paris BL³ and Asche CV³*

¹Neuro-ophthalmology, Moran Eye center, University of Utah School of Medicine, USA

²Illinois Neurological Institute , OSF Saint Francis Medical Center, USA

³Department of Medicine / Center for Outcomes Research, University of Illinois College of Medicine at Peoria, USA

*Corresponding author: Carl V Asche, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, USA

Received: November 12, 2015; Accepted: February 18, 2015; Published: February 22, 2016


Background: Multiple sclerosis (MS) is a chronic disease with high costs and impact on quality of life. Understanding the prevalence of comorbidities is important because comorbidities complicate management of MS.

Objective: Describe the comorbidities of MS patients seen at the Illinois Neurological Institute (INI) MS center.

Methods: Retrospective review of MS patients seen at the INI MS center from February 2011 to February 2014. Demographics and comorbidities were compared to a prior study of National Health and Wellness Survey (NHWS) 2009 data (N=549).

Results: A total of 592 patients were included in the study. Most frequent comorbidities were pain (45.0%), high cholesterol (28.8%) and hypertension (27.3%).

Conclusions: Primary care physicians and general neurologists should be aware that comorbidities exist and may complicate treatment.

Keywords: Multiple sclerosis; Prevalence; Retrospective studies; Comorbidity; Adult; Humans


An estimated 4,00,000 people in the United States have multiple sclerosis (MS) with approximately 10,000 new cases diagnosed every year [1]. In the US, prevalence of MS ranges from 47.2 to 109.5 per 1,00,000 population, with the rate affected by sunlight exposure, gender, age, and ethnicity [2]. Most individuals with MS experience initial symptoms between the ages of 20 and 40 years; therefore, this disease may have significant impact over time on their health, employment, productivity, and quality of life [3]. Multiple sclerosis is included in the World Health Organization (WHO) top 100 diseases affecting quality of life. Among those with MS, 30% are severely disabled and 70% are unemployed. As a result, the economic costs associated with MS are significant [3]. We spend 445 million USD on direct MS care annually [4], however annual indirect costs exceed 10 billion USD [2,5].

Managing MS requires treatment to help prevent disease progression and control a number of conditions including fatigue, bladder or bowel dysfunction, urinary tract infections, muscular weakness, spasticity, joint contractures, difficulty walking, tremor, vision disturbances, pain, loss of cognition, depression and anxiety, speech and swallowing difficulty, sexual dysfunction, and pressure ulcers [6]. These conditions are related to the progression of MS and may require physical therapy, occupational therapy, pharmacotherapy, medical devices, and counseling. Treating MS is intended to help avoid relapses leading to temporary disability and to delay progression of the disease which leads to permanent disability.

Comorbidities among MS patients complicate management. Cost of illness is higher, and health-related quality of life is lower for MS patients with impaired mobility [5], which is affected by comorbid conditions [7,8]. The prevalence of comorbid conditions with MS is high; 37% of patients with MS had at least one physical comorbidity [9] and 48% of patients with MS had at least one mental comorbidity [10]. Adverse health factors such as smoking and obesity are also common in MS [8,9,11,12]. These comorbidities and lifestyle factors may affect the delay between symptom onset and diagnosis, disability progression, and health related quality of life [7,9,11,12]. Comorbidity in MS adds to complexity of managing the disease.

Multiple studies have reported the prevalence of comorbid conditions in patients with MS [7,9,13-17], but the studies do not use a consistent framework for categorizing comorbidities. An improved understanding of the prevalence and nature of underlying comorbidities among those with MS is merited as it will serve to further develop treatment protocols, thus improving outcomes among MS patients. Population based studies of individuals with MS are needed along with appropriate comparator groups [8]. The objective of this paper is to describe the demographics, geographic patient distribution, and comorbidities of MS patients seen at the INI MS center. To assist the reader in interpreting our data, we compare the individual comorbidity prevalence in the INI MS Center population to the MS comorbidity prevalence reported by Stewart and colleagues [16].

Patients and Methods

This is a retrospective review of MS patients seen at the Illinois Neurological Institute (INI) from February 2011 to February 2014. The INI MS Center serves approximately 600 people living with multiple sclerosis in Central Illinois, many of whom live in rural areas and travel to the city of Peoria for treatment. (Figure 1) shows the geographic area served by the INI MS Center and (Table 1) summarizes the demographic characteristics of patients seen at the INI MS Center (N=593). This study was approved by the IRB. A retrospective review of inpatient and outpatient claims data was undertaken using ICD-9 codes to determine comorbid conditions; these codes are presented in (Table 2).