{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T14:35:15Z","timestamp":1793198115325,"version":"4.5.0"},"reference-count":12,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Multiple Sclerosis Society and MS Canada","award":["EGID:P002\/903124\/3743"],"award-info":[{"award-number":["EGID:P002\/903124\/3743"]}],"id":[{"id":"https:\/\/ror.org\/03019wv17","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Multiple Sclerosis Society and MS Canada","award":["RG5063A4\/1\/RFA-2103-37392"],"award-info":[{"award-number":["RG5063A4\/1\/RFA-2103-37392"]}],"id":[{"id":"https:\/\/ror.org\/03019wv17","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2026,2,15]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Increased healthcare use precedes classical multiple sclerosis (MS) symptom onset. Limited evidence exists on sex and age variation. We assessed physician visit patterns pre-MS onset by sex and age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from British Columbia, Canada, we compared annual physician visit rates (overall, by reason and specialty) in the 15 years before the neurologist-determined MS symptom onset date (index) and a matched non-MS cohort, stratified by sex and age (&lt;30, 30\u201349, \u226550).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 2038\u2009MS and 10\u2009182 non-MS persons (74% female). Mean age (years) at index was 37.6 (females) and 38.7 (males). Compared with matched non-MS persons, females with MS showed earlier and more consistent elevations in physician visits (years \u221214 to \u22121), while males had sporadic elevations (years \u22125, \u20133 and \u22121). Females also had longer periods of elevated rate ratios (RRs) for ill-defined signs\/symptoms (years \u221215 to \u22121), mental disorders (years \u221214 to \u22121 except year \u22127) and musculoskeletal conditions (years \u22126 to \u22121). Females exhibited sustained elevated visits by specialty, including general practice (all years; RR \u22651.1), psychiatry (years \u221212 to \u22121 except \u22128 to \u22126; RRs \u22651.6) and ophthalmology (years \u22129 to \u22121 except \u22122; RRs \u22651.4). Compared with matched non-MS counterparts, those aged 30\u201349 years had sustained higher RRs for psychiatry visits (years \u221212 to \u22121 except \u22128 and \u22126; RRs \u22651.9) and ophthalmology (years \u22129 to \u22121; RRs \u22651.4). Other age groups had fewer elevated RRs preindex. Across comparisons, RRs were of similar magnitude across sex and age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sex-specific and age-specific differences in physician visits extended up to 15 years pre-MS onset, suggesting a durable prodromal signature, most evident in females and those aged 30\u201349\u2009years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnnp-2025-338045","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T17:20:25Z","timestamp":1773422425000},"page":"600-603","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Sex-related and age-related differences in healthcare use before multiple sclerosis symptom onset: a matched cohort study"],"prefix":"10.1136","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0857-0684","authenticated-orcid":false,"given":"Marta","family":"Ruiz-Alguer\u00f3","sequence":"first","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farahnaz","family":"Amini","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinshan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1855-5595","authenticated-orcid":false,"given":"Ruth Ann","family":"Marrie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (Neurology), Max Rady College of Medicine, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB, Canada"},{"name":"Department of Medicine and Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada"},{"name":"Nova Scotia Health, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5804-2535","authenticated-orcid":false,"given":"Helen","family":"Tremlett","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"2026102807300980000_97.7.600.1","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.jval.2024.10.3847","article-title":"Healthcare Costs in the United States by Demographic Characteristics and Comorbidity Status","volume":"28","author":"Adjei","year":"2025","journal-title":"Value Health"},{"key":"2026102807300980000_97.7.600.2","doi-asserted-by":"crossref","DOI":"10.3390\/ijms22073696","article-title":"A Case of Double Standard: Sex Differences in Multiple Sclerosis Risk Factors","volume":"22","author":"Angeloni","year":"2021","journal-title":"Int J Mol Sci"},{"key":"2026102807300980000_97.7.600.3","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2022.1017492","article-title":"Sex and age differences in the Multiple Sclerosis prodrome","volume":"13","author":"Yusuf","year":"2022","journal-title":"Front Neurol"},{"key":"2026102807300980000_97.7.600.4","doi-asserted-by":"crossref","DOI":"10.1177\/1756286420960274","article-title":"Gender disparities in health resource utilization in patients with relapsing-remitting multiple sclerosis: a prospective longitudinal real-world study with more than 2000 patients","volume":"13","author":"Schriefer","year":"2020","journal-title":"Ther Adv Neurol Disord"},{"key":"2026102807300980000_97.7.600.5","doi-asserted-by":"crossref","DOI":"10.1177\/1756286420936166","article-title":"Sex effects across the lifespan in women with multiple sclerosis","volume":"13","author":"Krysko","year":"2020","journal-title":"Ther Adv Neurol Disord"},{"key":"2026102807300980000_97.7.600.6","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1212\/WNL.0000000000002481","article-title":"Sex differences in comorbidity at diagnosis of multiple sclerosis","volume":"86","author":"Marrie","year":"2016","journal-title":"Neurology (ECronicon)"},{"key":"2026102807300980000_97.7.600.7","doi-asserted-by":"publisher","DOI":"10.1177\/1756285613488434"},{"key":"2026102807300980000_97.7.600.8","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1002\/acn3.52267","article-title":"Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex","volume":"12","author":"Tremlett","year":"2025","journal-title":"Ann Clin Transl Neurol"},{"key":"2026102807300980000_97.7.600.9","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2025.24635","article-title":"Health Care Use Before Multiple Sclerosis Symptom Onset","volume":"8","author":"Ruiz-Alguer\u00f3","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026102807300980000_97.7.600.10","unstructured":"Canadian Institute for Health Information; Statistics Canada . Health indicators 2013. 2024. Available: https:\/\/www.cihi.ca\/sites\/default\/files\/document\/health-indicators-2013-en.pdf"},{"key":"2026102807300980000_97.7.600.11","unstructured":"The Maelstrom Catalogue . The British Columbia Multiple Sclerosis Historical Database. 2026. Available: https:\/\/www.maelstrom-research.org\/study\/bcms"},{"key":"2026102807300980000_97.7.600.12","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181e3973f"}],"container-title":["Journal of Neurology, Neurosurgery &amp; Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jnnp-2025-338045","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T14:30:30Z","timestamp":1793197830000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnnp.bmj.com\/lookup\/doi\/10.1136\/jnnp-2025-338045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,13]]},"references-count":12,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,6,12]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/jnnp-2025-338045"],"URL":"https:\/\/doi.org\/10.1136\/jnnp-2025-338045","relation":{},"ISSN":["0022-3050","1468-330X"],"issn-type":[{"value":"0022-3050","type":"print"},{"value":"1468-330X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,13]]}}}