Sex differences in healthcare use before the first multiple sclerosis-related demyelinating event.

Authors

Farahnaz Amini, Karl Everett, Feng Zhu, Ping Li, Kyla A McKay, Yinshan Zhao, Colleen J Maxwell, Ruth Ann Marrie, Helen Tremlett

Published in

Multiple sclerosis and related disorders. Volume 113. Pages 107360. Jul 02, 2026. Epub Jul 02, 2026.

Abstract

While the multiple sclerosis (MS) prodrome may be prolonged, healthcare use by sex >5 years pre-onset remains underexplored. We examined healthcare use up to 29 years pre-MS onset, stratified by sex. Using administrative data from Ontario, Canada (1991-2020), we compared annual physician visit rates by diagnostic chapter between MS and matched non-MS cohorts, stratified by sex. Quasi Poisson models estimated rate ratios (RRs) with 95% confidence intervals (CI). Included were 35,018 MS and 136,007 matched non-MS individuals (mean onset age ∼43 years; standard deviation ∼14 years; ∼69% female in both cohorts). Sex differences were observed for nervous system-related visits; males exhibited higher RRs from 10 years pre-onset ('year -10'), peaking in year -1 for both sexes (RRs: males=28.60;95%CI:24.10-34.00, females=13.60;95%CI:12.56-14.70). This was followed by mental disorders, being higher for males from year -4, peaking in year -1 (RRs: males=2.98;95%CI:2.73-3.25; females=2.09;95%CI:1.99-2.21), then ill-defined signs/symptoms and injury-related visits from year -3 to -1 (e.g., ill-defined signs/symptoms, RRs range: males=1.85-4.26 and females=1.67-3.27). Additionally, males had higher RRs in the 1-2 years pre-onset for respiratory, genitourinary, musculoskeletal, circulatory, digestive, and infection-related visits. Sex differences in healthcare use were evident up to 10 years pre-MS onset across multiple diagnostic chapters. Findings suggest that prodromal MS patterns differ by sex, potentially reflecting differences in symptom presentation, health-seeking behaviour, or diagnostic recognition before MS onset.

PMID:
42424859
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

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