Impairments and comorbidities of polyneuropathy revealed by population-based analyses
Abstract
Objective:
To quantify polyneuropathy impairments and comorbidities utilizing the Rochester Epidemiology Project (2010 census = 148,201).
Methods:
ICD-9-CM coding identified polyneuropathy cases (2006–2010) and their 5:1 age- and sex-matched controls. Mortality and impairments were evaluated while identifying and adjusting for Charlson Index comorbidities.
Results:
Overall prevalence of polyneuropathy was 1.66%, and markedly rose to 6.6% in persons older than 60 years. Cases (n = 2,892) had more comorbidities than controls (n = 14,435) with higher median Charlson Index (6 vs 3, p < 0.001). Diabetes with end-organ disease represented the largest increased comorbidity in cases compared with controls (46.8% vs 6.5%). Diabetic polyneuropathy was the most common specific subtype (38.2%). Miscoded idiopathic cases and false-negative controls also commonly had diabetic polyneuropathy. Median modified Rankin Scale score was considerably higher for cases than controls (4 vs 1, p < 0.001). Multiple comorbidities were found associated with polyneuropathy after adjusting for diabetes co-occurrence, including pulmonary disease, dementia, and others. Polyneuropathy was an independent contributor to multiple functional impairments including difficulty walking (odds ratio [OR] = 1.9), climbing stairs (OR = 2.0), using an assistive device (OR = 2.0), fall tendency (OR = 2.4), work disability (OR = 4.2), lower limb amputations (OR = 3.9), and opioid use (OR = 2.7). Prevalent cases had a younger median age at death than controls (80 vs 86 years, p < 0.001), and incident cases had a 6-month shorter survival.
Conclusions:
Polyneuropathies have notable neurologic impairments beyond their identified multiple comorbidities. Life expectancy is shortened. Diabetic polyneuropathy is underidentified. The quantified extent of the disease burden and refined comorbidity associations emphasize that greater research efforts and health care initiatives are needed.
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Information & Authors
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Copyright
© 2015 American Academy of Neurology.
Publication History
Received: August 24, 2014
Accepted: January 6, 2015
Published online: April 1, 2015
Published in print: April 21, 2015
Disclosure
E. Hoffman, N. Staff, J. Robb, and J. St. Sauver report no disclosures relevant to the manuscript. P. Dyck is an associate editor of Diabetes and receives an honorarium for this work. He receives personal and laboratory support from ISIS Pharmaceuticals Inc. and Alnylam Pharmaceuticals Inc. C. Klein is a coeditor of Journal of the Peripheral Nervous System. Go to Neurology.org for full disclosures.
Study Funding
The Mayo Foundation for Medical Education and Research, the Mayo Clinic Center for Individualized Medicine, Rochester Epidemiology Project, and NIH: RO1 AG034676 (Rochester Epidemiology Project), K08 NS065007 (C.J.K.), K08 CA169443-02 (N.P.S.), UL1 RR000135 (Clinical and Translational Sciences Award).
Authors
Author Contributions
E.M.H. and N.P.S.: data collection, analysis and interpretation of data, drafting and revising the manuscript. J.M.R.: data collection and analysis. J.L.S.: analysis and interpretation of data. P.J.D.: drafting and revising the manuscript. C.J.K.: concept, supervision, data collection, analysis and interpretation of data, drafting and revising the manuscript.
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