- •Children with multiple sclerosis (MS) have more hospitalizations and physician visits than healthy children.
- •Among children with MS, more relapses are associated with increased odds of hospitalization.
- •Better cognitive accuracy scores are associated with fewer physician visits.
We assessed whether clinical characteristics and health-related quality of life (HRQOL) are independently associated with subsequent hospitalizations and physician visits among children with multiple sclerosis (MS); and whether differences in HRQOL account for differences in physician visits between children with MS, monophasic acquired demyelinating syndromes (ADS) and healthy children.
We used linked administrative (health) data from Ontario, Canada and data from a prospective cohort study including HRQOL (measured using the PedsQL), age, sex, cognitive function (accuracy and response time as assessed by Penn Neurocognitive Battery), number of relapses, and neurologic abnormalities on examination. We used generalized linear models with generalized estimating equations to examine factors associated with hospitalizations and ambulatory physician visit rates following each HRQOL assessment, adjusting for age, sex, and socioeconomic status.
: We included 36 children with MS, 43 with monophasic ADS and 43 healthy controls. Among children with MS, more relapses were associated with increased odds of hospitalization (odds ratio 1.59; 1.18–2.14); better cognitive accuracy scores were associated with fewer physician visits (rate ratio [RR] 0.68; 0.47–0.98). Children with MS had higher rates of physician visits than healthy children (RR 1.44; 1.00–2.08), unlike children with a monophasic ADS, but HRQOL scores did not account for these differences.
: Within the MS population, more relapses are associated with increased odds of hospitalization while better cognitive performance is associated with reduced rates of physician visits. Differences in HRQOL do not account for differences in physician visits by children with MS as compared to healthy children.
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- National health surveys and the behavioral model of health services use.Med. Care. 2008; 46: 647-653
- Executive dysfunction in paediatric-onset multiple sclerosis: deficits above and beyond slowed processing speed.Mult Scler. J. 2017; 23: 85-426
- Characteristics of children and adolescents with multiple sclerosis.Pediatrics. 2016; 138e20160120
- Health care use and health and functional impact of developmental disabilities among US children, 1997-2005.Arch. Pediatr. Adolesc. Med. 2009; 163: 19-26
- National Health Expenditure Trends 1975-2008..Canadian Institute for Health Information, Ottawa, Ontario2008
- Collinearity: a review of methods to deal with it and a simulation study evaluating their performance.Ecography. 2013; 36: 27-46
- Memory and identification of emotional expression in pediatric-onset multiple sclerosis.Mult. Scler. 2018; 24: 328-529
- Predictors of children’s healthcare use: the value of child versus parental perspectives on healthcare needs.Med. Care. 2004; 42: 232-238
- Pediatric versus adult MS: similar or different?.Mult. Scler. Demyelinating Disord. 2017; 2: 5
- Age group and sex differences in performance on a computerized neurocognitive battery in children age 8-21.Neuropsychology. 2012; 26: 251-265
- A cognitive neuroscience-based computerized battery for efficient measurement of individual differences: standardization and initial construct validation.J. Neurosci. Methods. 2010; 187: 254-262
- The linkage between pediatric quality of life and health conditions: establishing clinically meaningful cutoff scores for the PedsQL.. 2009; 12: 773-781
- To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health.Epidemiology. 2010; 21: 467-474
- Recommendations for cognitive screening and management in multiple sclerosis care.Mult. Scler. J. 2018; 24: 1665-1680
- Hospital admission rates for pediatric multiple sclerosis in the United States using the Pediatric Health Information System (PHIS).Mult. Scle. Related Dis. 2016; 9: 5-10
- "Health-related quality of life predicts emergency department utilization for patients with asthma.Ann. Emerg. Med. 2004; 43: 551-557
- Dramatically changing rates and reasons for hospitalization in multiple sclerosis.Neurology. 2014; 83: 929-937
- Incidence and prevalence of MS in children: a population-based study in Ontario, Canada.Neurology. 2018; 91: e1579-e1e90
- High rates of health care utilization in pediatric multiple sclerosis: a Canadian population-based study.PLoS One. 2019; 14e0218215
- Comorbidities are associated with altered health services use in multiple sclerosis: a prospective cohort study.Neuroepidemiology. 2018; 51: 1-10
- Pediatric acquired demyelinating syndrome (ADS) in inpatient hospital settings: the hospitalization rate, costs, and outcomes in the US.Mult. Scle. Related Dis. 2019; 34: 150-157
- Variation within households in consent to link survey data to administrative records: evidence from the UK Millennium Cohort Study.Int. J. Soc. Res. Methodol. 2016; 19: 355-375
- Health-related quality of life is reduced in pediatric multiple sclerosis.Pediatr. Neurol. 2010; 43: 97-102
- Assessing ecologic proxies for household income: a comparison of household and neighbourhood level income measures in the study of population health status.Health Place. 1999; 5: 157-171
- Pediatric-onset multiple sclerosis is associated with reduced parental health-related quality of life and family functioning.Mult. Scler. 2018; 1352458518796676
- Recovery from central nervous system acute demyelination in children.Pediatrics. 2015; 136: e115-e123
- Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.Ann. Neurol. 2011; 69: 292-302
- Predicting health care utilization for children with respiratory insufficiency using parent-proxy ratings of children’s health-related quality of life.J. Pediatr. Health Care. 2017; 31: 654-662
- The clinical utility of health-related quality of life screening in a pediatric inflammatory bowel disease clinic.Inflamm. Bowel Dis. 2013; 19: 2666-2672
- Health-related quality of life as a predictor of pediatric healthcare costs: a two-year prospective cohort analysis.Health Qual. Life Outcomes. 2004; 2: 48
- Using health-related quality of life to predict and manage pediatric healthcare.Expert Rev. Pharmacoecon. Outcomes Res. 2005; 5: 489-498
- Health-related quality of life in pediatric patients with demyelinating diseases: relevance of disability, relapsing presentation, and fatigue.J. Pediatr. Psychol. 2018; 43: 133-142
- Health-related quality of life predicts future health care utilization and mortality in veterans with self-reported physician-diagnosed arthritis: the veterans arthritis quality of life study.Semin. Arthritis Rheum. 2005; 34: 755-765
- Peds metrics: quantifying the qualitative.The PedsQL Measurement Model for the Pediatric Quality of Life Inventory 4.0. 1998
- The PedsQLTM* 4.0 as a pediatric population health measure: feasibility, reliability, and validity.Ambul. Pediatr. 2003; 3: 329-341
- How young can children reliably and validly self-report their health-related quality of life?: An analysis of 8,591 children across age subgroups with the PedsQLTM 4.0 Generic Core Scales.Health Qual. Life Outcomes. 2007; 5: 1
- Examining predictors of healthcare utilization in youth with inflammatory bowel disease.Eur. J. Gastroenterol. Hepatol. 2016; 28: 469-474
- Comprehensive population-based determination of pediatric multiple sclerosis health care costs.Neurol.(R) Neuroimmunol. Neuroinflamm. 2017; 4: e314
Published online: November 06, 2019
Accepted: November 5, 2019
Received in revised form: November 2, 2019
Received: June 15, 2019
© 2019 Elsevier B.V. All rights reserved.