Associations Between ALS Disease Type of Onset and Comorbidities in a Puerto Rican Cohort
Maria Bonilla1, Frances Aponte-Caraballo2, Shelimar Olmo2, Fernando Padron2, Brenda Deliz Roldan3, Valerie Wojna3
1Ponce Health Sciences University, 2CHALS-CCT University of Puerto Rico Medical Sciences Campus, 3Neurology Division, UPR MSC SoM
Objective:
This study aimed to characterize the comorbidity profile of patients with Amyotrophic Lateral Sclerosis (ALS) in Puerto Rico and assess associations between specific comorbidities and ALS type of onset (bulbar or spinal).
Background:
Previous research has found associations between certain comorbidities and the progression of ALS, such as diabetes mellitus that could be considered a potential protective factor. Given Puerto Rico's high prevalence of chronic conditions and the limited research on ALS, this study sought to explore these possible associations.
Design/Methods:
A retrospective transversal study was conducted using data from the ALS Patient Registry in Puerto Rico (CELA-PR). Inclusion criteria required patients to have had a confirmed ALS diagnosis by June 2025 and complete data on comorbidities and type of disease onset (n = 121). Descriptive statistics and bivariate analysis (t-tests, chi-square) were performed. Associations were determined using Firth’s logistic regression to address potential bias due to small sample size.
Results:
In the cohort, the most prevalent comorbidities were hypertension (47.4%), diabetes (27.0%), and high cholesterol (17.5%). Bulbar ALS type of onset was significantly associated with asthma (OR = 6.12, 95% CI 1.64–33.21, p = 0.006), hypothyroidism (OR = 4.61, 95% CI 1.77–13.34, p= 0.001), and depression (OR = 4.18, 95% CI 1.50–13.18, p = 0.006). Spinal ALS onset showed a complementary, statistically significant inverse association with the same conditions. Multimorbidity was significantly associated with higher odds of having bulbar ALS type of onset (OR = 5.73, 95% CI 1.83–23.18, p = 0.002).
Conclusions:
These findings suggest that specific comorbidities and multimorbidity are significantly associated with bulbar onset ALS. In contrast, spinal onset results may reflect underlying pathophysiological differences between onset types. These results highlight the need to study comorbidities and their role in ALS, particularly in populations that have a high burden of chronic disease.
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