Low Socioeconomic, Education Levels Linked to Higher Disability and Disease Progression in MS, Study Says

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by Joana Carvalho, PhD |

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Low income and education levels are linked to a higher risk of physical disability and disease progression in patients with multiple sclerosis (MS), study says.

The study with that finding, “Socioeconomic status and disability progression in multiple sclerosis,” was published in the journal Neurology.

“This study is the first of its kind,” Helen Tremlett, PhD, the study’s senior author, said in a press release. Tremlett is a professor at the University of British Columbia (UBC) and the Canada Research Chair in neuroepidemiology and MS.

“Previous studies have looked at the relationship between socioeconomic status and risk of developing MS. Here, we were able to show a relationship between socioeconomic status and subsequent risk of disability progression,” Tremlett said.

MS is a progressive, neurodegenerative, autoimmune disease characterized by different types and degrees of physical disabilities. The impact of patients’ socioeconomic status on MS progression and physical disability is controversial. “These discrepancies might relate to variability between study designs, especially when adjusting for lifestyle factors, which can change over time,” the researchers wrote.

In the study, a team of scientists from UBC, Canada, together with collaborators from Wales, U.K., set out to assess whether the socioeconomic status and education level of MS patients were linked to disease progression and physical disabilities.

To this end, researchers gathered health, economic, and education data from two different groups of MS patients stored on census records, and on two MS online databases. The study included a total of 3,113 MS patients — 2,069 from British Columbia (Canada), and 1,044 from Southeast Wales (U.K.).

The patients’ socioeconomic status was evaluated before MS onset, to eliminate any potential confounding factors, and was based on neighborhood-level average income. Physical disability was evaluated using the Expanded Disability Status Scale (EDSS, the higher the score, the worse the patient’s disability).

Results showed that high socioeconomic status, as well as education levels, were associated with a low risk of high EDSS scores, and a low risk of developing secondary progressive MS (SPMS). Conversely, low socioeconomic status and/or education levels were linked to a high risk of moderate/severe physical impairment and SPMS.

These findings were not surprising for Marilyn Lenzen, a 59-year-old patient living in North Vancouver, Canada, who was diagnosed with MS nearly 20 years ago.

“I’m glad to see that there is now research that backs up what I and many in the MS community have been experiencing for years,” said Lenzen. “Someone who has the financial means to buy healthier food or afford to participate in yoga, pilates or specialized exercise to rebuild their strength after a relapse doesn’t experience the same progression of disabling symptoms as others who can’t afford to access the same healthy lifestyle choices,” she said.

The team did not analyze which factors might account for this inverse relationship between patients’ socioeconomic status/education level and higher risk of MS disability and progression, but argue that several lifestyle parameters, including diet and exercise, may be involved.

“If that is the case, the risk may be amenable to change,” said Tremlett. “One of the next steps is to understand why this relationship exists.”

In the future, the team hopes that more MS studies will take into account the socioeconomic status and education level of patients, since these parameters seem to play an important role in disease progression and physical disability.

“I wish that everyone with MS, regardless of their socioeconomic status, has the same lifestyle opportunities to slow the progression of their disease,” Lenzen concluded.

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