The impact of disease-modifying drugs for multiple sclerosis on hospitalizations and mortality in British Columbia : a retrospective study using an illness-death multi-state model
department or school: Science, Faculty of
department or school: Statistics, Department of
data provider: DSpace
degree campus: UBCV
creator: Kempf, Graeme
issued: 2024-08-27T17:58:28Z
issued: 2024
related degree: Master of Science - MSc
degree grantor: University of British Columbia
description: Multiple sclerosis (MS) is an autoimmune disease that progresses over the course of years. MS is treated with disease-modifying drugs (DMDs). The efficacy of DMDs was established in clinical trials that were short and excluded older individuals and individuals living with comorbidities. This has led to a lack of knowledge of the effects of chronic DMD use and the effects of DMDs on individuals that do not meet the traditional eligibility criteria for clinical trials. This thesis applies multi-state models, which can advance the understanding of a disease beyond that offered by time-to-event models alone, to administrative healthcare data in a retrospective study to explore the long-term, real-world efficacy of DMDs. Chapter 2 applies time-to-event models and weighted cumulative exposure to explore the association between DMDs and mortality as well as to explore reverse causality. Chapters 3 and 4 implement an illness-death model to investigate the main research questions of this thesis: whether exposure to any DMD is associated with fewer hospitalizations, shorter hospitalizations, and/or a reduction in the chance of dying inside or outside the hospital. Specifically, in Chapter 3, Cox-type regressions estimate the hazard ratios (HRs) for exposure to any DMDs. In Chapter 4, pseudo-value regression models examine whether exposure is associated with more time spent alive and out of the hospital or more time hospitalized. Chapters 3 and 4 use interactions between DMD and comorbidity to analyze if the impact of DMDs changed across comorbidity burden. The change of the effects of exposure over time is also investigated in Chapters 2, 3, and 4. The results suggest that DMD use is initially associated with fewer hospitalizations but long-term DMD exposure is associated with more hospitalizations. Long-term DMD exposure is also associated with a greater hazard of dying outside the hospital. Pseudo-value regression suggested that exposure amongst individuals with high comorb…
aggregated CHO: https://circle.library.ubc.ca/rest/handle/2429/89047
note: The impact of disease-modifying drugsfor multiple sclerosis onhospitalizations and mortality inBritish ColumbiaA retrospective study using an illness-death multi-statemodelbyGraeme KempfB.B.A., Wilfrid Laurier University, 2020B.Sc., Wilfrid Laurier University, 2022A THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF SCIENCEinTHE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES(Statistics)THE UNIVERSITY OF BRITISH COLUMBIA(Vancouver)August 2024© Graeme Kempf 2024The following individuals certify that they have read, and recommend tothe Faculty of Graduate and Postdoctoral Studies for acceptance, the thesisentitled:The impact of disease-modifying drugs for multiplesclerosis on hospitalizations and mortality in BritishColumbia: a retrospective study using an illness-death multi-state modelsubmitted by Graeme Kempf in partial fulfillment of the requirements forthe degree of Master of Science in StatisticsExamining Committee:John Petkau, Professor Emeritus, Department of Statistics, UBCCo-supervisorYinshan Zhao, Research Associate, Department of Medicine (Neurology),Senior Data Scientist, Population Data BC, UBCCo-supervisorLang Wu, Professor, Department of Statistics, UBCSupervisory Committee MemberiiAbstractMultiple sclerosis (MS) is an autoimmune disease that progresses over thecourse of years. MS is treated with disease-modifying drugs (DMDs). Theefficacy of DMDs was established in clinical trials that were short and ex-cluded older individuals and individuals living with comorbidities. This hasled to a lack of knowledge of the effects of chronic DMD use and the effectsof DMDs on individuals that do not meet the traditional eligibility criteriafor clinical trials. This thesis applies multi-state models, which can advancethe understanding of a disease beyond that offered by time-to-event modelsalone, to administrative healthcare data in a retrospective study to explorethe long-term, real-world efficacy of DMDs.Chapter 2 applies time-to-e…
has type: Thesis/Dissertation
date issued: 2024-11
is shown at: 10.14288/1.0445171
language: eng
degree discipline: Statistics
provider: Vancouver : University of British Columbia Library
publisher: University of British Columbia
rights: Attribution-NonCommercial-NoDerivatives 4.0 International
rights URI: http://creativecommons.org/licenses/by-nc-nd/4.0/
scholar level: Graduate
contributor: Petkau, A. John, 1950-
contributor: Zhao, Yinshan
type: Text
identifier URI: http://hdl.handle.net/2429/89047