Delayed diagnosis in multiple sclerosis: Unraveling risk factors in a Brazilian setting

Address for correspondence: Mateus Boaventura de Oliveira (email: [e-mail]).

Abstract

Background: Several multiple sclerosis (MS) diagnostic criteria have been updated over the last decades, aiming to improve accuracy and early diagnosis. However, other factors may continue to contribute to a delayed diagnosis, potentially resulting in a faster progression rate of the disease.

Objective: To expand the perspective on factors contributing to delayed diagnosis despite the evolution of diagnostic criteria.

Methods: A multicenter cross-sectional study was conducted. Multivariable logistic regression examined whether age, sex, race, level of schooling, functional system affected, health insurance availability at disease onset, and autoimmune familial history were associated with delayed diagnosis. The time gap between disease onset and the official diagnosis was considered delayed when surpassing 12 months.

Results: We included 208 patients (78.4% of female subjects; mean age at diagnosis of 32.1 years; mean disease duration of 9.1 years; and median EDSS score of 2.0). Older age was significantly associated with delayed diagnosis (p = 0.008). Women had early diagnosis in 60.1% of the cases, contrasting with 40% among men, but with no statistical significance in the adjusted analysis. Access to private insurance significantly reduced the likelihood of delay by 75%. Patients with an autoimmune family history were diagnosed early in 68.3% of the cases, compared with 49.2% of those without such history (p = 0.013). Sensory symptoms were significantly associated with early diagnosis (p = 0.027). The independent factors for delayed diagnosis after multivariable logistic regression were: older age, no access to private healthcare at the onset of the first symptom, absence of family history, and first symptom not involving the sensory functional system. Lower level of schooling and race (non-white) only showed a trend towards an association with delayed diagnosis.

Conclusion: The factors associated with delayed diagnosis include age, type of healthcare access, autoimmune family history, and functional system affected. Our findings reinforce the importance of carrying out a correct diagnostic workup in addition to expanding and improving public health care.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
02 October 2024