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A multi-national study of socioeconomic status and disability progression in multiple sclerosis
Author(s): ,
K. Harding
Affiliations:
Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada; Institute for Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, United Kingdom
,
M. Wardle
Affiliations:
Institute for Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, United Kingdom
,
R. Carruthers
Affiliations:
Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
,
N. Robertson
Affiliations:
Institute for Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, United Kingdom
,
F. Zhu
Affiliations:
Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
,
E. Kingwell
Affiliations:
Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
H. Tremlett
Affiliations:
Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
ECTRIMS Online Library. Harding K. Oct 12, 2018; 228839; P997
Katharine Harding
Katharine Harding
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Abstract: P997

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Epidemiology

Background: Lower socioeconomic status (SES) is known to be associated with poor outcomes in many conditions including cardiovascular disease, diabetes and stroke. While SES has been explored in relation to multiple sclerosis (MS) risk, little is known about the relationship between SES and subsequent disability. We examined the association between SES and both disability and progression in MS.
Methods: Health administrative and MS clinical data were linked for two cohorts of MS patients in British Columbia (Canada) and South East Wales (UK). SES was measured at MS symptom onset (±3 years), based on neighbourhood-level average income. Demographic features, including sex, initial disease course and age at onset, were compared by SES quintile using chi-squared test (sex and initial disease course) and linear regression (age at onset). The association between SES and sustained and confirmed Expanded Disability Status Scale (EDSS) 6.0 and 4.0, and onset of secondary progression (SPMS), were assessed using Cox proportional hazards models. EDSS scores were also examined via linear regression, using generalised estimating equations (GEE) with an exchangeable working correlation structure. Models were adjusted for onset age, sex, initial disease course and disease-modifying drug exposure. Random effect models (meta-analysis) were used to combine results from the two cohorts.
Results: 3113 MS patients were included (2069 from Canada; 1044 from Wales). There were no differences in the distribution of sex (χ2=1.88, p=0.76) or initial disease course (χ2=3.33, p=0.50) by SES quintile, but age at onset increased with higher SES (β=0.79, 95% CI:0.48;1.10). A higher SES at MS onset was associated with a lower hazard of reaching EDSS 6.0 (adjusted hazard ratio (aHR=0.90, 95%CI:0.89; 0.91), EDSS 4.0 (aHR=0.93, 95% CI:0.88; 0.98), and SPMS (aHR=0.94, 0.88; 0.99). The direction of findings was similar when all EDSS scores were included (GEE: β=-0.13, 95% CI:-0.18;-0.08).
Conclusions: A higher SES at MS onset was associated with a lower risk of disability progression, with similar findings for EDSS 6.0, EDSS 4.0 and onset of SPMS in two different jurisdictions. The reasons for this association are likely to be complex but could include factors amenable to modification, such as lifestyle or comorbidity. Our findings are relevant for development of MS services. Further studies are warranted to investigate potential modifiable aspects of SES that might improve MS outcomes.
Disclosure: Dr Harding was funded for this study by a MS Society of Canada fellowship and has received research support from Novartis for work that is unrelated to this study.
Mark Wardle reports no disclosures.
Robert Carruthers is Site Investigator for clinical trials funded by Novartis, Med-Immune, and Roche; receives research support from Teva Innovation Canada, Roche Canada and Vancouver Coastal Health Research Institute; has done consulting work and has received honoraria from Roche, EMD Serono, Sanofi, Biogen, Novartis, and Teva.
Neil Robertson has received honoraria and/or support to attend educational meetings from Biogen, Novartis, Genzyme, Teva, Roche, and has also received research support from Biogen, Novartis and Genzyme.
Mr Zhu has nothing to disclose.
Dr Kingwell is funded through operating grants from the Canadian Institutes of Health Research, the USA's National MS Society and the MS Society of Canada.
Helen Tremlett is the Canada Research Chair for Neuroepidemiology and Multiple Sclerosis and in the last 3 years has received research support from: the MS Society of Canada, the MS Scientific and Research Foundation, the US National Multiple Sclerosis Society; the Canadian Institutes of Health Research, the Canada Foundation for Innovation and the UK MS Trust.

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