Comorbidities in Multiple Sclerosis Associated With Diagnostic Delays, Mortality Risk

Doctor listening to patients chest
Doctor listening to patients chest
As early treatment of multiple sclerosis is crucial, it is important to identify the factors that may delay diagnosis.

Increased awareness and assessment of any new neurologic symptoms in individuals with multiple sclerosis (MS) with preexisting, chronic comorbidities is critical as it may have an impact on the diagnosis and mortality in MS, according to study results published in Neurology.

Patients enrolled in the analysis included all incident cases of MS in Denmark who presented with onset of initial MS symptoms between 1980 and 2005. The investigators compared individuals with and without chronic comorbidities in order to evaluate time of diagnosis.

A total of 8947 persons with MS were enrolled in the study. Of these, 8862 and 8848 eligible patients were evaluated in the studies of diagnostic delay and mortality, respectively. 

Longer diagnostic delays (5 to 10 years vs 0 to 5 years) were associated with statistically significant odds ratios (ORs) for cardiovascular comorbidity (OR 1.95; 95% CI, 1.49-2.56; P <.0005) and lung comorbidity (OR 1.24; 95% CI, 1.02-1.52; P =.033). Diagnostic delays of >10 years vs 0 to 5 years were associated with significant ORs for cerebrovascular comorbidity (OR 2.01; 95% CI, 1.44-2.80; P <.0005), lung comorbidity (OR 1.93; 95% CI, 1.42-2.62; P <.0005), diabetes comorbidity (OR 1.78; 95% CI, 1.04-3.06; P =.035), and cancer comorbidity (OR 2.10; 95% CI, 1.20-3.67; P =.009).

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In the mortality study, significantly higher hazard ratios (HRs) were exhibited in patients with psychiatric comorbidity (HR 2.42; 95% CI, 1.67-3.01; P <.0005), diabetes comorbidity (HR 1.39; 95% CI, 1.05-1.85; P =.021), cancer comorbidity (HR 3.51; 95% CI, 2.94-4.19; P <.0005), and Parkinson disease comorbidity (HR 2.85; 95% CI, 1.34-6.06; P =.007).

The researchers concluded that comorbidities in patients with MS have a significant negative impact both at the beginning of the disease, as demonstrated in the delay between MS onset and MS diagnosis, and at the end of the disease course, as shown in mortality rates.


Thormann A, Sørensen PS, Koch-Henriksen N, Laursen B, Magyari M. Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality. Neurology. 2017;89(16):1668-1675.