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Pediatric multiple sclerosis in the United States in children ages 0–18

Published:November 25, 2019DOI:https://doi.org/10.1016/j.msard.2019.101874

      Highlights

      • 869 weighted cases of pediatric multiple sclerosis were found in 2016 of ages 0–18.
      • Male to female admission ratio of Pediatric multiple sclerosis was 1:2.4.
      • Mean total charges of Pediatric MS were $50,379.72.
      • Mean length of stay of Pediatric MS admissions was 4.62 days.

      Keywords

      Pediatric multiple sclerosis (Pediatric MS), previously known as juvenile multiple sclerosis or early onset multiple sclerosis (EOMS), is the onset of multiple sclerosis in children below 18. It is believed that only 5% of all multiple sclerosis cases occur before the age of 18 and only 1% below 1 year of age. (
      • Boiko A.
      • Vorobeychik G.
      • Paty D.
      • Devonshire V.
      • Sadovnick D.
      Early onset multiple sclerosis: a longitudinal study.
      ;
      • Duquette P.
      • Murray T.J.
      • Pleines J.
      • et al.
      Multiple sclerosis in childhood: clinical profile in 125 patients.
      ;

      Lotze T.E. Pathogenesis, clinical features, and diagnosis of pediatric multiple sclerosis. 2017; https://www.uptodate.com/contents/pathogenesis-clinical-features-and-diagnosis-of-pediatric-multiple-sclerosis. Accessed 15 October 2018.

      )
      There are limited research data available on the burden of pediatric multiple sclerosis in the United States. Herein, we investigated various aspects of pediatric multiple sclerosis in the US from the Kid's Inpatient Database (KID) 2016 provided by the Healthcare Cost Utilization Project (HCUP). The HCUP is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and their partners. The KID includes data from over 3 million patients below the age of 21 and provides a national estimate for pediatric discharges. It is made available every three years. The most current data of 2016, released in 2018, included over 40 states and 4000 hospitals. (
      Healthcare Cost and Utilization Project
      Overview of the Kids’ Inpatient Database (KID).
      ;

      Partner Organizations Providing Data to HCUP. 2018; www.hcup-us.ahrq.gov/hcupdatapartners.jsp. Accessed 1 December 2018.

      )
      International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code for multiple sclerosis, 'G35′, was applied to identify all cases of MS. (
      Healthcare Cost and Utilization Project
      Clinical Classifications Software (CCS) for ICD-10-PCS (beta version).
      ) We restricted the age group of our study to patients of ages between 0 and 18 inclusive. Data was weighted using the kid discharge weight (DISCWT) sampling scheme provided in the database to obtain more accurate national estimates.
      SPSS 20.0 software (IBM Corporation, USA) was used to conduct statistical analysis. We investigated differences in sex, race, admission month, region of hospital, payer form as well as median household incomes. Mean and median age of admission, length of stay and total hospital charges were also calculated. Categorical variables were studied using Chi-square test or Fisher exact test. An analysis of variance (ANOVA) was used for comparing continuous variables in our study. For further comparison of the data, linear regression models were also set up if required. Statistical significance was set at p < 0.05.
      The 2016 KID consisted of 6266,285 weighted admissions for children aged between 0 and 20. On further analysis, we narrowed our database to 5765,224 admissions for children aged 18 or less. There were 869 weighted admissions for patients who had a diagnosis multiple sclerosis (Table 1). 259(29.8%) were males and 610(70.2%) were females (P < 0.001). The Southern part of the US had the highest admission rate for pediatric MS with 382 cases (44.0%) (P = =0.001) and the highest number of admissions was seen in white children (318 cases, 40.0%, p < 0.001)
      Table 1Characteristics of patients with Multiple sclerosis aged 18 or less.
      CharacteristicMultiple sclerosis (%)P-value
      Sex<0.001
      Male259 (29.8)
      Female610 (70.2)
      Race<0.001
      White318 (40.0)
      Black201 (25.7)
      Hispanic209 (26.3)
      Asian or Pacific Islander16 (2.0)
      Native American and other48 (6.0)
      Admission month0.067
      January84 (9.7)
      February75 (8.6)
      March64 (7.4)
      April72 (8.3)
      May58 (6.7)
      June76 (8.7)
      July69 (7.9)
      August80 (9.2)
      September97 (11.2)
      October74 (8.5)
      November63 (7.2)
      December57 (6.6)
      Region of hospital0.001
      Northeast129 (14.8)
      Midwest149 (17.1)
      South382 (44.0)
      West209(24.1)
      Median household income national quartile0.128
      0–25th percentile285 (33.4)
      26th−50th percentile193 (22.6)
      51st−75th percentile207 (24.2)
      76th–100th percentile169 (19.8)
      Primary expected payer<0.001
      Medicaid445 (51.2)
      Private insurance355 (40.9)
      Self-pay21 (2.4)
      Medicare, No charge or other48 (5.5)
      The highest monthly admission rate was noted in September (97 cases, 11.2%) but it was not statistically significant (P = =0.067). There was also no statistical significance in the median household income (P = =0.128) despite data showing that MS was higher among families within the 0–25th quartile (285 cases, 33.4%).
      Medicaid was the most common form of payer for children with MS (445 cases, 51.2%) followed by private insurances (355 cases, 40.9%) (P < 0.001). The mean age of admission was 15.08, median of 16.00 with a standard deviation of 2.955 (P < 0.001). We further analyzed the ages as show in Fig. 1. A gradual rise in admission was seen from age 13–18 despite a drop at age 17. Mean total charges were $50,379.72 (B = 21,995.688, 95% confidence interval: 13,453.798–30,537.578, P < 0.001), while the mean length of stay (LOS) of MS admissions was 4.62 days.
      Fig. 1
      Fig. 1A steady rise in admission rate was seen from ages 13 to 18 with a drop at age 17. Admissions for multiple sclerosis at age 0–5 consisted of 1.27% of all pediatric MS admissions.
      Multiple sclerosis is a multifactorial condition (

      Ysrraelit M.C., Correale J.Impact of sex hormones on immune function and multiple sclerosis development. 2018.

      ) and our study showed that pediatric multiple sclerosis had a male to female admission ratio of 1:2.4. This finding is very identical to findings among adult multiple sclerosis patients. (
      • Alonso A.
      • Hernan M.A.
      Temporal trends in the incidence of multiple sclerosis: a systematic review.
      ) The racial differences in the prevalence of pediatric multiple sclerosis and the higher incidence among Caucasian white children are also compliant to similar comparisons made among the adult population. (
      • Kingwell E.
      • Marriott J.J.
      • Jette N.
      • et al.
      Incidence and prevalence of multiple sclerosis in Europe: a systematic review.
      ) The combined higher population of Caucasian and Hispanics in the southern regions of the United States could explain the results shown by the KID ().
      There are several limitations to our study. ICD-10 code for multiple sclerosis can also include “MOG related demyelination” and children with possible but not confirmed MS. Our study was not able to distinguish first admissions from readmissions of MS. However, since the HCUP's KID provides a very large sample, we believe that our study can be used as a stepping stone to further clinically investigate the findings.

      Declaration of Competing Interest

      The authors have no conflict of interest to declare.

      Funding

      We received no grants or financial help for this article.

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