Abstract Details

Title Associations Between ALS Disease Type of Onset and Comorbidities in a Puerto Rican Cohort

Topic Global Health and Neuroepidemiology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 20-001

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.

Authors/Disclosures
Maria F. Bonilla PRESENTER	Ms. Bonilla has nothing to disclose.
Frances M. Aponte-Caraballo, MS (CHALS-CCT University of Puerto Rico Medical Sciences Campus)	Miss Aponte-Caraballo has received personal compensation for serving as an employee of Fundación ALS de Puerto Rico. Miss Aponte-Caraballo has received research support from AIM-AHEAD Data Science Training Core Training Practicum (PRIME) Program.
Shelimar Olmo-Colón, MS-Epidemiology	Miss Olmo-Colón has nothing to disclose.
Fernando Padrón, BA	Mr. Padrón has nothing to disclose.
Brenda Deliz-Roldan, MD, FAAN	Dr. Deliz-Roldan has nothing to disclose.
Valerie E. Wojna, MD, FAAN (Nuerology Division, UPR MSC SoM)	Dr. Wojna has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Puerto Rico Health Sciences Journal, University of Puerto Rico Medical Sciences Campus. The institution of Dr. Wojna has received research support from NIH.

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