title: Comorbidity delays diagnosis and increases disability at diagnosis in MS.
abstract: BACKGROUND
  Comorbidity is common in the general population and is associated with adverse health outcomes. In multiple sclerosis (MS), it is unknown whether preexisting comorbidity affects the delay between initial symptom onset and diagnosis ("diagnostic delay") or the severity of disability at MS diagnosis.
  
  
  OBJECTIVE
  Using the North American Research Committee on Multiple Sclerosis Registry, we assessed the association between comorbidity and both the diagnostic delay and severity of disability at diagnosis. In 2006, we queried participants regarding physical and mental comorbidities, including date of diagnosis, smoking status, current height, and past and present weight. Using multivariate Cox regression, we compared the diagnostic delay between participants with and without comorbidity at diagnosis. We classified participants enrolled within 2 years of diagnosis (n = 2,375) as having mild, moderate, or severe disability using Patient Determined Disease Steps, and assessed the association of disability with comorbidity using polytomous logistic regression.
  
  
  RESULTS
  The study included 8,983 participants. After multivariable adjustment for demographic and clinical characteristics, the diagnostic delay increased if obesity, smoking, or physical or mental comorbidities were present. Among participants enrolled within 2 years of diagnosis, the adjusted odds of moderate as compared to mild disability at diagnosis increased in participants with vascular comorbidity (odds ratio [OR] 1.51, 95% CI 1.12-2.05) or obesity (OR 1.38, 95% CI 1.02-1.87). The odds of severe as compared with mild disability increased with musculoskeletal (OR 1.81, 95% CI 1.25-2.63) or mental (OR 1.62, 95% CI 1.23-2.14) comorbidity.
  
  
  CONCLUSIONS
  Both diagnostic delay and disability at diagnosis are influenced by comorbidity. The mechanisms underlying these associations deserve further investigation.
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, MB, Canada. rmarrie@hsc.mb.ca
authors.forename: R A
authors.initials: RA
authors.lastname: Marrie
authors.forename: R
authors.initials: R
authors.lastname: Horwitz
authors.forename: G
authors.initials: G
authors.lastname: Cutter
authors.forename: T
authors.initials: T
authors.lastname: Tyry
authors.forename: D
authors.initials: D
authors.lastname: Campagnolo
authors.forename: T
authors.initials: T
authors.lastname: Vollmer
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003951:Diagnostic Errors / Q000517:prevention & control*; D004185:Disability Evaluation; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology*; D009140:Musculoskeletal Diseases / Q000453:epidemiology; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors