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Apparent Regional Variation in MS Disability Progression in Sweden Reflects Clinic‐Level Heterogeneity.

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Title: Apparent Regional Variation in MS Disability Progression in Sweden Reflects Clinic‐Level Heterogeneity.
Authors: Hedström, Anna Karin (AUTHOR), Guo, Jie (AUTHOR), Johansson, Eva (AUTHOR), Olsson, Tomas (AUTHOR), Alfredsson, Lars (AUTHOR), Dhoundiyal, Ankit (AUTHOR)
Source: Acta Neurologica Scandinavica. 6/3/2026, Vol. 2026, p1-9. 9p.
Subjects: Disease progression, Regional disparities, Health service areas, Multiple sclerosis
Geographic Terms: Sweden
Abstract: Background: Geographic gradients in multiple sclerosis (MS) incidence are well described, but whether long‐term disability progression varies across regions, and to what extent clinic‐level factors contribute, remains unclear. Methods: We included 8260 people with relapsing‐onset MS from two nationwide cohorts linked to the Swedish MS registry. Primary analyses focused on incident cases (n = 3160), the full cohort was used for complementary analyses. The primary exposure was healthcare region (Stockholm–Gotland reference). Outcomes were confirmed disability worsening (CDW) and time to EDSS 3 and EDSS 4. Cox models estimated region‐specific hazard ratios (HRs) with 95% confidence intervals (CI). Shared‐frailty models with clinic as a random effect accounted for within‐region clinic heterogeneity. Within‐region contrasts compared the three largest clinics in selected regions (anonymized). Two‐sided p values < 0.05 were considered statistically significant. Analyses were performed using SAS version 9.4. Results: In incident cases, the Northern and Western regions showed consistently lower risks of CDW and of reaching EDSS 3 and EDSS 4 than Stockholm–Gotland. The South‐Eastern region had a lower risk for CDW (HR 0.74, 95% CI 0.59–0.94). After accounting for clinic‐level heterogeneity, regional contrasts attenuated and were no longer significant, as illustrated by the South‐Eastern region (HR 0.87, 95% CI 0.59–1.18). The full cohort showed similar geographic patterns. Within‐region clinic comparisons revealed substantial heterogeneity despite a shared regional context. Conclusions: Apparent regional variation in long‐term MS disability progression in Sweden largely reflects between‐clinic differences rather than broad geographic gradients. Observed differences between clinics may reflect contributions from lifestyle‐related factors, clinic practices, and other unmeasured influences. [ABSTRACT FROM AUTHOR]
Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Apparent Regional Variation in MS Disability Progression in Sweden Reflects Clinic‐Level Heterogeneity.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hedstr&#246;m%2C+Anna+Karin%22&quot;&gt;Hedstr&#246;m, Anna Karin&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Guo%2C+Jie%22&quot;&gt;Guo, Jie&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Johansson%2C+Eva%22&quot;&gt;Johansson, Eva&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Olsson%2C+Tomas%22&quot;&gt;Olsson, Tomas&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Alfredsson%2C+Lars%22&quot;&gt;Alfredsson, Lars&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Dhoundiyal%2C+Ankit%22&quot;&gt;Dhoundiyal, Ankit&lt;/searchLink&gt; (AUTHOR)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Acta+Neurologica+Scandinavica%22&quot;&gt;Acta Neurologica Scandinavica&lt;/searchLink&gt;. 6/3/2026, Vol. 2026, p1-9. 9p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Disease+progression%22&quot;&gt;Disease progression&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Regional+disparities%22&quot;&gt;Regional disparities&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Health+service+areas%22&quot;&gt;Health service areas&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Multiple+sclerosis%22&quot;&gt;Multiple sclerosis&lt;/searchLink&gt;
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  Data: Background: Geographic gradients in multiple sclerosis (MS) incidence are well described, but whether long‐term disability progression varies across regions, and to what extent clinic‐level factors contribute, remains unclear. Methods: We included 8260 people with relapsing‐onset MS from two nationwide cohorts linked to the Swedish MS registry. Primary analyses focused on incident cases (n = 3160), the full cohort was used for complementary analyses. The primary exposure was healthcare region (Stockholm–Gotland reference). Outcomes were confirmed disability worsening (CDW) and time to EDSS 3 and EDSS 4. Cox models estimated region‐specific hazard ratios (HRs) with 95% confidence intervals (CI). Shared‐frailty models with clinic as a random effect accounted for within‐region clinic heterogeneity. Within‐region contrasts compared the three largest clinics in selected regions (anonymized). Two‐sided p values &lt; 0.05 were considered statistically significant. Analyses were performed using SAS version 9.4. Results: In incident cases, the Northern and Western regions showed consistently lower risks of CDW and of reaching EDSS 3 and EDSS 4 than Stockholm–Gotland. The South‐Eastern region had a lower risk for CDW (HR 0.74, 95% CI 0.59–0.94). After accounting for clinic‐level heterogeneity, regional contrasts attenuated and were no longer significant, as illustrated by the South‐Eastern region (HR 0.87, 95% CI 0.59–1.18). The full cohort showed similar geographic patterns. Within‐region clinic comparisons revealed substantial heterogeneity despite a shared regional context. Conclusions: Apparent regional variation in long‐term MS disability progression in Sweden largely reflects between‐clinic differences rather than broad geographic gradients. Observed differences between clinics may reflect contributions from lifestyle‐related factors, clinic practices, and other unmeasured influences. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1155/ane/4582085
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      – Code: eng
        Text: English
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        PageCount: 9
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    Subjects:
      – SubjectFull: Disease progression
        Type: general
      – SubjectFull: Regional disparities
        Type: general
      – SubjectFull: Health service areas
        Type: general
      – SubjectFull: Multiple sclerosis
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      – SubjectFull: Sweden
        Type: general
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      – TitleFull: Apparent Regional Variation in MS Disability Progression in Sweden Reflects Clinic‐Level Heterogeneity.
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              Text: 6/3/2026
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              Y: 2026
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