{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:18:51Z","timestamp":1786976331694,"version":"build-2736575974"},"reference-count":57,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000261","name":"Multiple Sclerosis Society of Canada","doi-asserted-by":"publisher","award":["EGID: P002\/903124"],"award-info":[{"award-number":["EGID: P002\/903124"]}],"id":[{"id":"10.13039\/501100000261","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000890","name":"National Multiple Sclerosis Society","doi-asserted-by":"publisher","award":["RG5063A4\/1\/RFA\u20102103\u201037392"],"award-info":[{"award-number":["RG5063A4\/1\/RFA\u20102103\u201037392"]}],"id":[{"id":"10.13039\/100000890","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Phenotype hospital, physician, and emergency department (ED) visits by diagnoses and specialty up to 29\u2009years pre\u2010multiple sclerosis (MS) onset versus a matched population without MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified people with MS (PwMS) using population\u2010based administrative data from Ontario, Canada (1991\u20132020). The first MS\/demyelinating diagnostic code defined MS onset (the index date). Annual rates of healthcare use (hospital, physician, ED) by primary diagnosis (chapter\u2010level) and physician specialty pre\u2010index were compared between PwMS and up to 5 matched population comparators using overdispersed\u2010Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Up to 35,018 PwMS and 136,007 population comparators were included. Consistently elevated yearly physician visit rate ratios (RRs) were observed 28\u2009years pre\u2010index for: mental\u2010health (RR &gt;\u20091.29) and ill\u2010defined signs\/symptoms (RR &gt;\u20091.15), 24\u2009years for: nervous (RR &gt;\u20091.47), musculoskeletal (RR &gt;\u20091.21), injury, and respiratory\u2010related issues (RR &gt;\u20091.07), and 22\u2009years for digestive\u2010system (RR &gt;\u20091.18). The magnitude increased as the index date approached, peaking the year pre\u2010index for physician, hospital, and ED visit RRs for: nervous\u2010system (range: 12.06\u201317.13); ill\u2010defined signs\/symptoms (range: 3.51\u20135.45), mental\u2010health (range: 2.13\u20132.70), musculoskeletal (range: 1.84\u20132.96), injury (range: 1.58\u20132.27), digestive\u2010system (range: 1.49\u20131.78) and respiratory\u2010system (range: 1.37\u20132.06). By specialty, yearly visit RRs for primary care were &gt;\u20091.08 for 28\u2009years pre\u2010index, internal medicine exceeded 1.19 for 25\u2009years, and psychiatry and neurology &gt;\u20091.52 for 24\u2009years pre\u2010index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Higher healthcare use was evident for over two decades before the first demyelinating event. Mental\u2010related, ill\u2010defined signs\/symptoms and primary care visits were consistently elevated the longest (28\u2009years pre\u2010index), followed by nervous\u2010system, musculoskeletal, injury, respiratory\u2010related, and digestive\u2010system (22\u201324\u2009years pre\u2010index). Health\u2010related phenotypical differences appear early in the MS disease process.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acn3.70092","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T08:17:55Z","timestamp":1750148275000},"page":"1585-1594","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Phenotyping Healthcare Use 2\u20133 Decades Before the First Multiple Sclerosis Demyelinating Event"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5804-2535","authenticated-orcid":false,"given":"Helen","family":"Tremlett","sequence":"first","affiliation":[{"name":"Faculty of Medicine (Neurology), and the Djavad Mowafaghian Centre for Brain Health University of British Columbia  Vancouver British Columbia 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