{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T06:05:59Z","timestamp":1784700359685,"version":"3.55.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000261","name":"MS Canada","doi-asserted-by":"crossref","award":["EGID:P002\/903124"],"award-info":[{"award-number":["EGID:P002\/903124"]}],"id":[{"id":"10.13039\/501100000261","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000890","name":"National MS Society","doi-asserted-by":"publisher","award":["RG5063A4\/1\/RFA-2103-37392"],"award-info":[{"award-number":["RG5063A4\/1\/RFA-2103-37392"]}],"id":[{"id":"10.13039\/100000890","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Little is known about the prodrome in pediatric-onset multiple sclerosis (POMS), especially potential age and sex differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To compare annual hospitalization and physician visit rates overall, and for physician visits, examine sex- and age-group (&lt;12, 12\u201315, 16 to &lt;18\u2009years) differences, up to 18 years pre-first demyelinating event (pre-index) in 451 POMS and 1420 matched non\u2013multiple sclerosis (MS) individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>Using Ontario administrative data (1991\u20132020), we estimated rate ratios (RRs) by visit-related diagnosis, sex, and age using over-dispersed-Poisson models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The POMS cohort showed elevated rates by year 1 pre-index (\u201cyear \u22121\u201d), for ill-defined, other-health-contact, mental-, and respiratory-related hospitalizations (RRs\u2009\u2a7e\u20093.6). Elevated physician visits began at year \u221214 for respiratory (RRs\u2009\u2a7e\u20091.3), year \u221213 for endocrine (RRs\u2009\u2a7e\u20092.4) and injury-related (RRs\u2009\u2a7e\u20091.2), year \u221212 for ill-defined (RRs\u2009\u2a7e\u20091.3), and year \u221211 for nervous system (RRs\u2009\u2a7e\u20094.0) and mental-related (RRs\u2009\u2a7e\u20092.0). Nervous system visits showed the largest sex-gap; males with (vs without) MS had elevated RRs from year \u221212 and females from year \u22126; both peaked the year pre-index (males: RR\u2009=\u200947.2; 95% confidence interval (CI): 17.3\u2013128.3; females: RR\u2009=\u200917.0; 95% CI: 8.9\u201332.3). Among 12- to 15-year-olds, elevated rates were sustained for respiratory-related (from year \u221212, except year \u22125), injury-related, and ill-defined (from year \u221213); (all RR\u2009\u2a7e\u20091.3), while findings were more sporadic in the other age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Findings suggest prolonged, organ-specific healthcare use pre-POMS, with some sex- and age-related differences indicating pre-onset disease heterogeneity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261445372","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T06:22:09Z","timestamp":1779517329000},"page":"927-937","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Phenotyping healthcare use before pediatric-onset multiple sclerosis, including by sex and age: A matched cohort study"],"prefix":"10.1177","volume":"32","author":[{"given":"Farahnaz","family":"Amini","sequence":"first","affiliation":[{"name":"Faculty of Medicine (Neurology), The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Everett","sequence":"additional","affiliation":[{"name":"ICES, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Li","sequence":"additional","affiliation":[{"name":"ICES, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyla A","family":"McKay","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinshan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen J","family":"Maxwell","sequence":"additional","affiliation":[{"name":"ICES, Toronto, ON, Canada; Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, ON, 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 Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; 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