Proceedings of the 25th BCTRIMS Annual Meeting

Introduction: Several 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: 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, educational level, functional system affected, health insurance availability at disease onset and autoimmune familial history were associated with delayed diagnosis. Time gap between the disease onset and official diagnosis was considered delayed when surpassing 12 months. 

Results: We included 208 patients (78.4% females; mean age at diagnosis was 32.1 years, mean disease duration of 9.1 years and median EDSS score was 2.0).  Older age was significantly associated with delayed diagnosis (p=0.008). Women had early diagnosis in 60.1% of cases, contrasting with 40% in 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 cases, compared to 49.2% 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 first symptom, absence of family history and first symptom not involving the sensory functional system. Lower education and race (non-white) only showed a trend to be associated with delayed diagnosis.

Conclusion: The associated factors 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.