Background: Early recognition of multiple sclerosis (MS) remains a pivotal challenge. Little is understood about the trajectories of health care use before recognition of adult-onset MS, and the relationship of the trajectories with subsequent disability.

Methods: We accessed linked clinical and population-based health administrative data in British Columbia, Canada (1991-2020). Using group-based multi-trajectory models, we described the joint trajectories of physician visits, hospitalizations, and prescription classes filled in the 10 years preceding MS recognition - either the first recorded demyelinating event (administrative index date, n = 6349) or MS symptom onset (clinical index date, n = 725) at age ≥ 18 years. Across the identified trajectories, we compared demographics and encounters potentially related to MS pre-index-date. In the clinical cohort, we assessed the relationship between the trajectories and disability scores using a linear mixed-effects model, adjusting for confounders.

Results: Before the administrative index date, we identified 3 trajectories: low (57 % of cohort), moderate (36 %), and high (6 %) health care use. Before the clinical index date, we also identified low (51 %), moderate (40 %), and high (9 %) trajectories. In both cohorts, individuals in the moderate and high (versus low) trajectories were more likely to be female and older, and have earlier neurologist and ophthalmologist visits, and nervous system diagnoses pre-index-date. The moderate (versus low) trajectory was associated with higher subsequent disability (adjusted beta coefficient=0.31;95 %CI:0.09-0.53).

Conclusions: Earlier detection of MS by general practitioners and prompt MS drug treatment may be possible for patients accessing health care frequently, potentially mitigating disability progression.

Keywords: Health care utilization; Multiple sclerosis; Trajectory analysis.

Copyright © 2025. Published by Elsevier B.V.

背景：

早期识别成人发病的多发性硬化症（MS）仍然是一个关键挑战。对于在MS被确诊前医疗卫生使用轨迹以及这些轨迹与后续残疾之间的关系，目前了解甚少。

方法：

我们访问了加拿大不列颠哥伦比亚省1991年至2020年间链接的临床和人口健康行政数据。利用基于多轨迹模型的方法，描述了在MS被识别前10年内的医生就诊、住院以及处方药物类别的使用联合轨迹——无论是记录的第一个脱髓鞘事件（管理索引日期，n = 6349）还是症状出现时（临床索引日期，n = 725），年龄均需≥18岁。在确定的各轨迹中，我们比较了与MS相关的预索引日期人口学特征和就诊情况。在临床队列中，我们使用线性混合效应模型评估不同轨迹与残疾评分之间的关系，并调整混杂因素的影响。

结果：

在管理索引日期前，我们识别出3条轨迹：低水平（占队列的57%）、中等水平（36%）和高水平（6%）医疗使用。在临床索引日期前，我们也发现了三条轨迹：低水平（51%）、中等水平（40%）以及高水平（9%）。在这两个队列中，在中等及高水平轨迹中的个体更有可能是女性、年龄更大，并且在预索引日期之前有较早的神经科和眼科就诊经历，同时有更多的神经系统诊断。与低水平相比，中等水平轨迹与更高的后续残疾评分相关（调整后的β系数=0.31；95%CI：0.09-0.53）。

结论：

通过全科医生更早地识别MS并迅速进行药物治疗对于频繁使用医疗服务的患者可能是可能实现的，这有助于减缓残疾的发展进程。

关键词：

医疗卫生利用；多发性硬化症；轨迹分析。